Penile adhesions after circumcision
I have a ten month old son who was circumcised shortly after birth (about 1 month old). He has been a little heavy and his penis has been an "innie" for the last 10 months. Now, he is beginning to walk and lose weight and his penis is no longer constantly covered by the foreskin. However, now his circumcision has begun to grow back. My pediatrician has already ripped it back once (very cruel, no anesthesia, resulted in a red swollen, uncomfortable little boy for a few days), and it has still reattached. Should I wait for a while and have this procedure (this time with some type of anesthesia) performed again? Or should it right itself as he grows older?
Thank you for your assistance.Question:
The complication that you describe is called penile adhesions. Whenever tissues of the body are cut, the edges will tend to stick to the surrounding tissues. This is most often seen in abdominal surgery. Any surgeon will tell you it is much easier to perform surgery in an area that has never been operated on in the past. This is due to adhesion formation that occurs at the site of healing. It is also true for burn victims. As the skin begins to heal, the adhesions in areas of joints can significantly decrease the range of motion.
Circumcision is no different. The foreskin surrounds the penis and has a natural but superficial attachment to the penis. This procedure involves first separating the foreskin from the penis and then making a circular incision to remove it. This circular edge will tend to stick to the penis as it heals. In addition, if a significant amount of the foreskin remains after circumcision, the irritation from the foreskin/penis separation component of circumcision may cause that foreskin to reattach to the penis. Full healing takes about two weeks, so if adhesions to the penis are going to develop, they usually do so within this time.
These adhesions can be prevented with a simple painless maneuver performed at home. The tip of the penis is called the glans. The base of the glans has an edge which is usually slightly darker in color and raised as compared to the rest of the penis. This edge should be viewed in its entirety with each diaper change. Starting approximately 48 hours after the circumcision, the skin of the shaft and any remaining foreskin should be gently retracted to allow for visualization of this edge of the glans. The actual timing of when to begin this "diaper change" retraction varies with the how the circumcision was done, so as always, it's best to check with the doctor before beginning this.
Julie, I am very sorry to hear of your baby's troubles. If the skin has reattached, the likelihood of it fixing itself is pretty small. In fact, it may become more of a problem (more adherent) as time passes, so correcting it sooner than later would be best. Most of the time, these tissues may be separated manually with minimal discomfort and trauma to the skin. However, if there is a more permanent adhesion or there is a significant amount of foreskin that remained after circumcision, removal of this remaining foreskin by a urologist may be required to insure this problem does not recur. If the adhesions are separated manually, doing the "diaper change" retractions for the following 2 weeks along with applying some over the counter antibiotic ointment to the base of the glans will go a long way to keeping this from happening again.
I hope this helps.