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Circumcision and Penile Adhesions in Infant
Q: My son will be six months in three days. He was circumcised when he was a day old. Two of my nephews had what was called "Penile Adhesions" and had to have the foreskin ripped back by their peds.
My sisters were both told that they should have been retracting the foreskin at every diaper change and this problem would never have happened. When my son had his procedure, I went in with him to observe it done. I was asking a lot of questions about retracting the foreskin to prevent adhesions and was told that I didn't need to do anything to him besides applying Vaseline at every diaper change for the first 24 hours and then keep the area clean with plain water until it is fully healed.
I have been noticing for the last six months that it seems he has a lot of extra skin on his penis and that his penis actually looks like it is sunken in all the time. Lately I have noticed that the foreskin around his penis appears to be attaching again.
Why is the skin adhering again? What can I do to get it unstuck? Does he have to go through what my nephews' did? Why does it seem like he has so much extra skin on his penis? Why is his penis appearing to be sunken in? Is any of this normal and what can I do to help this problem? Any information you may have for me would be greatly appreciated.
A: You apparently have had some experiences with circumcised boys that are weighing heavily on your mind, along with a whole bunch of questions. Let me try to answer many of them and hopefully put your mind at ease.
Circumcision (removal of the foreskin that covers the tip of the penis) is still a common procedure. How often a circumcision is performed varies by location, by religious background, and by race and ethnicity. Parents should determine what is in the best interest of their son, after understanding the pros and cons to circumcision. Once a circumcision has healed, little, if any, extra care is required. Complications of the procedure -- tightening of the foreskin, a concealed penis, excess skin, a little inflammation or irritation -- are very infrequent and generally minor.
Good hygiene is important regardless of whether a boy is circumcised or not, but not all problems can be prevented. Some of the penile problems you describe can actually happen with both circumcised and uncircumcised boys. As is the case with complications, most of these problems are minor.
As far as YOUR son is concerned, what you describe does seem quite normal and probably could not have been anticipated. If a small amount of foreskin remains, it is appropriate to gently pull it back each day during a bath or diaper change. A bit of Vaseline applied to the area as a lubricant certainly will not hurt. Sometimes the surfaces of skin do stick to each other resulting in adhesions. These adhesions can be pulled apart with gentle pressure, not "ripped." Also, check to be sure that the groove at the head of the penis is clean. A whitish material called smegma can collect in the area, but does not indicate any pathology.
I hope my explanations help a bit. If you still have trouble with the cosmetic appearance of his penis or the amount of skin that's there, let his doctor or a pediatric urologist examine him to directly address your concerns.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.