Before Circumcision
In infants and children, every child’s anatomy is different, and the shape or size of the penis and foreskin are also different.
The penis is sometimes rotated, bent or buried in pubic areas.
When parents arrange a circumcision, they may have in mind that the child will look like the father or the head of the penis may be completely exposed as religious or cultural requirements, but this is definitely not the case in some children.
Children develop differently as well. The degree of buried penis can change as the child grows older.
Hypospadias
Hypospadias describes an anatomical variant where the wee hole (external meatal opening) did not complete its development and did not close fully to the tip of the penis, leaving an opening along the underside of the penis.
The opening could be present away from the tip of the penis to the scrotum or perineum. This also requires hypospadias repair under general anaesthesia, and the foreskin may be helpful for this purpose, so circumcision must not be done until the hypospadias repair is done.
- In most cases, you can recognise it as the foreskin is hooded.
- In some cases, hypospadias may be present on an intact foreskin and described as megameatus or glandular hypospadias.
- This can only be recognised after retracting the foreskin and circumcision should be postponed until hypospadias repair is done.
Penile Variations
- Some babies, infants and children have long and skinny penises, and others short and fat penises.
- Some show bending to the left or to the right before or after circumcision.
- Some children’s penises are buried into the abdominal fat.
- Some are more bent than others, even more than 90 degrees.
This markedly bent penis is described as a penile chordee and requires paediatric urology to straighten. The foreskin is useful for this procedure in these cases, so circumcision should not be done until the corrective operation of penile chordee is performed under general anaesthesia in the hospital.
Buried Penis
Buried penis is very common nowadays. In most cases, it is mild and may not require any further corrective surgery, and it is possible to do circumcision.
Many boys have loose attachment of the skin to the shaft of the penis. In these children, there may be:
- High insertion of the scrotal skin along the underside of the shaft of the penis
- A pad of “puppy fat” in front of the pubic bone pushing the skin forward and away from the penis, which is anchored at its internal base to the pubic bone
The penis appears to disappear behind the skin, and this is sometimes referred to as:
- “Disappearing Penis Syndrome”
- “Buried penis”
- “Hidden penis”
- “Inconspicuous penis”
It is primarily an issue of loose attachment of the skin. It is usual for the penis to “reappear” by the time the child is about 1–6 years of age, with the reduction in this pubic fat and the growth of the child.
However, some older children or adults retain this appearance at rest, yet it looks and performs perfectly adequately in sexual situations.
Cosmetic Concerns After Circumcision
This anatomical variant causes parents concern after circumcision, because as the skin moves forward over the head of the penis, it appears that not enough skin has been removed. This is not the case.
The paediatric urologist (Mr A R Khan) has to estimate the length of skin to leave in order that when the child is grown, there will be enough skin to cover the erect penis and not leave too much area that will be covered by scar tissue. It is only in the infant years that the child may appear to have been inadequately circumcised.
It is very important in such boys that the parents retract the cut foreskin regularly to prevent the cut edge healing and attaching to the head of the penis after 3 days of separation of the ring circumcision and creating a cosmetic result that is not desired.
Therefore, if you notice that the skin of the penis is falling forward covering the head of the penis at any time after the operation, even up to a few years later (such that it looks like not enough skin was removed), then please have the child reviewed at our clinic by Dr Khan.
He will explain to you how to manage the skin so as not to form permanent attachments to the head of the penis, and he may have to separate the skin from the head (glans) of the penis for you at times or refer you to the GP for further management at a tertiary centre in the UK.
Disclaimer
The content on our website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice from Dr Khan regarding any medical questions or conditions developed after circumcision.