My Son Had A Penile Adhesion, And It Was Scary

A call from the school nurse in the middle of the school day is always unnerving. It is particularly worrisome as we are fighting a global pandemic, but a recent call from my school nurse sent me down a path that I had never been. My seven-year-old son was in her office crying. He had gone to the bathroom and his penis was bleeding. Super scary for him and alarming for me. I dropped what I was doing and got to school as soon as I could. His sad little freckled face looked up at me, “Mom, I am scared.” Talk about a heartbreak!

We got into the pediatrician immediately and they sent us to the bathroom for a urine simple. This seemed reasonable to me. I have had my share of UTI and bladder infections and have seen blood in my urine, so this made sense. When he tinkled, there was a bit of blood on his underwear, but nothing extreme. He winced and said that it was burning. Now I was sure. All he would need was a little antibiotic and off we would go.

We went back to the room and waited for the doctor to arrive. He came in and said that his urine was clear. Huh? How could that be? He asked him to climb up on the table so that he could examine him. The doctor asked about pain, injury, or if anything inappropriate had happened to him. He said no. After a very brief examination he looked up very matter-of-factly and said, “He has a penile adhesion.” He is my third son and I had never heard of this before. But apparently, it is very common. But unfortunately, it can be very uncomfortable too.

There are three types of penile adhesions and these can happen to both circumcised and uncircumcised penises. When there is an adhesion present, the skin on the penis effectively adheres itself and can cause pain. According to Verywell Mind, adhesions come in three forms:

Glandular Adhesion

This type of adhesion occurs when the skin that’s attached to the penile glans (head) covers the coronal margin, of the purple line that separates the shaft of the penis from the glans.

Penile Skin Bridge

This is a thicker adhesion that can be permanent and may need surgery to correct.

Cicatrix

This adhesion is scar tissue that develops when the penis drops back into the pubic fat pad, causing the surgical area to contract. This essentially traps the penis and makes it impossible for the glans to be exposed at all.

Penile adhesions are usually visible when changing a baby’s diaper, or bathing a child, but they are often not painful. The discomfort comes into play as the child grows and will often naturally correct itself.

In an uncircumcised penis, the foreskin will naturally release from the glans as a child grows. Once this happens naturally, the penis should be periodically retracted to help deter penile adhesions from occurring. Foreskin should never be forced back on an infant or young child’s penis. If the foreskin doesn’t naturally release, as a child get’s older, a doctor will look for signs of adhesion.

In a circumcised baby, an adhesion can occur if the skin is not retracted frequently enough during circumcision care. A penile adhesion can also occur in a circumcised baby as more fat develops in the pubic area. The skin can become irritated and the penis can appear trapped or like it is disappearing into the skin of the fat pad. In this case, the skin will also need to be retracted often to prevent adhesion.

Adhesions occur most often in babies as they are developing. The different types of penile adhesions require different types of treatment. To treat a glandular adhesion, it is normally necessary to keep the area moist with a substance like petroleum jelly. That will keep the area soft and eventually smegma, a mix of dead skin cells and oil secretions, will develop. While this may appear to be pus, it is perfectly safe. But you should always contact your pediatrician if you are not sure. Spontaneous erections also help to naturally release an adhesion.

If your baby has a skin bridge, the treatment can be more involved. Skin bridges can normally be surgically removed during an outpatient treatment. In rare cases, a circumcision revision may need to be performed.

A baby with a cicatrix, or a trapped penis, can require the use of a corticosteroid. This can be an effective way to avoid surgery, if it is used three times a day for three weeks. This medication will soften the skin enough that a physician, under local anesthesia, can manually retract it. This should never be done at home.

My son had a glandular adhesion. It has likely been there for a long time, but we never noticed it before because it caused no pain. The pediatrician explained that because he is growing, the adhesion is beginning to tear, which is causing it to bleed and be uncomfortable. Due to the fact that the area has few oil glands and is rather dry, the tearing is painful. We treat it with antibiotic ointment, to moisturize and prevent infection, and the irritation goes away quickly. He explained that it does not require surgery, as it is not thick or severe, but that it will naturally tear away on its own; it will just take time to do so.

In most cases, penile adhesions can be a normal part of development and are not cause for concern. However, if they cause pain, irritation, or seem to be infected, it is always a good idea to contact your pediatrician. It is better to be safe than sorry, particularly when dealing with such a delicate and sensitive area.