Penile Adhesions and Skin Bridges
What are penile adhesions and skin bridges?
Penile adhesions in circumcised boys occur when the penile shaft skin sticks, or adheres, to the glans of the penis. The glans is the bulbous structure at the end of the penis.
Skin bridges are a thicker, more permanent attachment. They occur when the skin on the shaft of the penis becomes attached to the coronal margin, which is the round border near the tip of the penis.
Symptoms and Causes
What are the causes of penile adhesions and skin bridges?
Penile adhesions and skin bridges can occur for a variety of reasons.
Adhesions can occur when the remaining skin is not frequently retracted (pulled back) when too much foreskin is left during a circumcision. They also can happen when the skin of the penis is pushed forward by a large fat pad in the pubic area, giving the penis a “buried” appearance.
Adhesions that are not treated can become skin bridges.
What are the symptoms of penile adhesions and skin bridges?
Penile adhesions and skin bridges often have no symptoms and cause no pain. If they persist as a child grows, however, he may notice a tugging feeling during erections.
Penile adhesions and skin bridges are usually visible to the naked eye. The penis may appear to be buried in the pubic fat pad.
If your child has adhesions, dead skin cells and oil can get trapped under the skin and create a white discharge called smegma. Though this looks like pus, it is not an infection.
Management and Treatment
How are penile adhesions and skin bridges treated?
Some penile adhesions may resolve on their own as an infant’s penis grows and with spontaneous erections.
Penile adhesions can be repaired in a urologist’s office or with a topical steroid cream that can be used at home. Repair in the urologist’s office requires a numbing lotion to be applied to your son’s penis prior to the adhesions being taken down. This lotion will stay on for 20-30 minutes prior to the adhesions being treated. The takedown of the adhesions takes approximately 5 minutes.
The steroid cream used at home needs to be applied twice per day for six weeks. The steroid cream thins the skin around the adhesions, allowing them to be slowly treated over time as the penile skin is pulled back with each diaper change. This cream can, however, cause skin discoloration (getting lighter or darker) in the surrounding penile skin. If you notice skin discoloration, stop using the cream immediately and contact your doctor.
In some cases, skin bridges can be divided (cut) in a doctor’s office after a numbing cream is applied. Other skin bridges may need to be divided in the operating room.
If your child is still in diapers, you will be asked to retract the extra skin several times per day and apply petroleum jelly such as Vaseline® to prevent adhesions. If the diaper is wet and sticky, this can increase the chance of penile adhesions.