Penile Adhesions and Skin Bridges

What are penile adhesions?

Penile adhesions in children occur when the skin on the shaft of their penis sticks (adheres) to the tip (glans) of their penis. It usually affects babies and can occur in circumcised or uncircumcised children.

What are the types of penile adhesions?

There are three types of penile adhesions:

• Glanular adhesion. A glanular adhesion is a minor type of penile adhesion. The skin on the shaft attaches to the glans. It usually goes away on its own or with minimal treatment.
• Penile skin bridge. This is a thicker, more permanent attachment. It occurs when the skin on the shaft attaches to the coronal margin. The coronal margin is the round border near the tip of the penis. A penile skin bridge usually needs treatment.
• Trapped or buried penis (cicatrix adhesion). Generally, this occurs when too much foreskin (prepuce) remains after a circumcision. The penis retracts into the large fat pad in the pubic area. The penis looks trapped or buried, and it’s difficult to expose the head of the penis.

Is it normal for the foreskin to be attached to the head?

Yes, it’s normal for the foreskin to attach to the head of an uncircumcised penis. Typically, over the first several years of your child’s life, the foreskin will separate from the glans. After this occurs, you can pull the foreskin away (retract) from the head of the penis. Most children with a foreskin should be able to retract it before they reach the age of 5. But some may take longer.

Is it bad if my foreskin is still attached?

Not necessarily. But teenagers and adults whose foreskin remains attached to the head of their uncircumcised penis (phimosis) should reach out to a healthcare provider.

What are the symptoms of penile adhesion?

Penile adhesion symptoms are usually mild, if there are any at all. They may include:

• A tugging feeling during erections.
• Mild pain or discomfort.
• The development of smegma under the penile adhesion.

What causes penile adhesions?

Penile adhesions can occur for a variety of reasons. The main cause is not pushing the penile skin off the head of your child’s penis and applying petroleum jelly (Vaseline®) the first month after a circumcision.

They can also occur after circumcision if too much foreskin remains. They can also develop when fat develops in the pubic area. A large fat pad in the pubic area can push the skin of the penis, which creates a buried or trapped appearance. In some cases, diaper rash and irritation can cause penile adhesions.

Without treatment, penile adhesions can become skin bridges.

How are penile adhesions diagnosed?

Penile adhesions usually don’t cause discomfort or pain, so it may not be evident that your child has a penile adhesion. In many cases, pediatricians notice them during a physical examination.

Can you get rid of penile adhesions?

Yes, you can treat a penile adhesion. Some penile adhesions may go away on their own as your infant’s penis grows and gets erections. Applying petroleum jelly can help soften the skin and cause a penile adhesion to disconnect faster during spontaneous erections.

Applying topical steroid cream around a penile adhesion can help gradually thin the skin until it separates. Steroid cream can cause discoloration (getting lighter or darker) in the surrounding penile skin. If you notice skin discoloration, stop using the steroid cream and contact a healthcare provider.

In some cases, a healthcare provider can use a scalpel (knife) to cut a skin bridge in an office setting. More serious skin bridges may require surgical separation.

How painful is penile adhesion surgery?

Penile adhesion surgery is moderately painful. Pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and topical anesthetics can help reduce pain and discomfort.

How soon after treatment will it take to feel better?

Mild penile adhesions may go away with little or no recovery period. It may take up to two weeks to recover after surgery.

Can penile adhesions be prevented?

Penile adhesions can develop from spending a lot of time in wet or sticky diapers, so it’s a good idea to change your child’s diaper regularly. You can also help prevent penile adhesions by retracting the foreskin several times per day and applying petroleum jelly.

What can I expect if my child has a penile adhesion?

The outlook for penile adhesions is good. They’re usually mild, and they may go away on their own without treatment. Talk to your child’s pediatrician if you notice a penile adhesion. If necessary, they can recommend the proper treatment.

When should I see a healthcare provider?

Schedule an appointment with your child’s pediatrician if you notice what looks like a penile adhesion. They can officially diagnose a penile adhesion and recommend treatment if necessary.

When should I take my child to the ER?

A penile adhesion isn’t usually an emergency. But go to the nearest emergency room if your child has surgery to treat a penile adhesion and develops any of the following symptoms:

• A fever of 101 degrees Fahrenheit (38 degrees Celsius) or higher.
• Nausea and vomiting.
• Diarrhea.
• Discoloration (red, purple or dark brown) around the surgery site.
• A foul smell in the area.
• Increased pain.
• Heavy bleeding around the area or bleeding that doesn’t stop.
• Problems peeing.

What questions should I ask a healthcare provider?

• How can I tell if my child has a penile adhesion?
• What type of penile adhesion does my child have?
• Does my child need treatment?
• What treatment do you recommend?
• Can my child get a penile adhesion again?