Penoscrotal webbing is a fold of skin extending from the underside of the penis to the scrotum. It pulls the scrotal skin upwards and may give the appearance of a shorter penis. It is also called webbed penis, penoscrotal fusion, penoscrotal web, or congenital penile–scrotal fusion.
Penoscrotal webbing may be present from birth or may develop after a tight circumcision where too much skin has been removed.
Men may want to correct penoscrotal webbing because of the appearance of a short penis, difficulty applying a condom, discomfort during exercise, painful erections, or pain during sexual activities. It may also cause a loss of the normal penoscrotal angle and lead to the formation of a “turkey-neck deformity”, which can cause concerns during sexual intercourse or psychological issues.
How Common Is Penoscrotal Webbing?
Penoscrotal webbing is uncommon. A study of 5,881 newborns reported a prevalence of around 4%.
Symptoms and How to Check for Penoscrotal Webbing
Penoscrotal webbing may be suspected if:
- The scrotal skin attaches higher than normal onto the underside of the penis
- The penis appears shorter
- There is discomfort during erections or sexual activity
A simple check involves gently pulling the penis upwards and the scrotal skin downwards. If a web-like fold of skin is seen, penoscrotal webbing may be present.
Diagnosis is confirmed by a physical examination.
Causes of Penoscrotal Webbing
Penoscrotal webbing may be:
- Congenital (present from birth)
- Acquired, usually after over-resection of skin during excessive circumcision
- Classified as mild, moderate, or severe, depending on the degree of attachment to the penis
Difference Between Penoscrotal Webbing and Buried Penis
Penoscrotal webbing is not the same as a buried penis.
- A buried penis is hidden due to excess skin or fat around the penis.
- Penoscrotal webbing occurs when scrotal skin attaches too high onto the underside of the penis.
Severe webbing may contribute to a partially buried appearance, but the conditions are separate and treated differently.
Diagnosis
Penoscrotal webbing is diagnosed through a clinical examination. The surgeon assesses the attachment of the scrotal skin, the degree of webbing, the appearance of the penile shaft, and any associated discomfort during erections or sexual activity. The penoscrotal angle is also evaluated to determine the degree of fusion.
Operations for Penoscrotal Webbing
The type of operation depends on whether the webbing is mild, moderate, or severe.
Mild Webbing
- A transverse incision that is closed vertically
- Dog-ear edges must be excised to avoid an uneven appearance
- Mild cases may also be treated with a single or double Z-plasty
Moderate Webbing
- Excision of triangular skin at the penoscrotal area with a V-Y plasty
- A scrotal lift, scrotoplasty, or scrotal reduction may be required separately
Severe Webbing
- Excision of excess skin along the midline
- A Z-plasty at the penoscrotal junction to prevent recurrent scar tightening
A double-V penoscrotal repair is also described in medical literature.
Scrotal reduction is not recommended in younger patients, as it may affect testes temperature regulation and lead to infertility.
We carry out penoscrotal repair for medical reasons. We do not do the procedure for cosmetic reasons.
Cost of Penoscrotal Webbing Repair
The cost is £1500, which includes repair of the penoscrotal web only (not scrotal lift or scrotal reduction).
Aftercare
- You may experience pain for a few days; simple painkillers help reduce discomfort
- Passing urine is usually normal
- Swelling and bruising of the penis and scrotum may last 2–3 weeks and will gradually settle
- Bleeding is uncommon and can be controlled with pressure or a bandage
- A self-adhesive stretch gauze dressing (Cobain) is applied around the wound line for three days
- The wound takes 2–3 weeks to heal
- Most people can return to work in 2–3 days, except manual workers
- Heavy work should be avoided for 1–2 weeks
- Gentle rinsing can begin after 10 days, once the wound is dry
- Avoid gym activities and lifting weights for 2-3 weeks
- Avoid sexual activity for 4–6 weeks to prevent wound breakdown
Risks of Penoscrotal Web Repair
The wound is commonly bruised around the incision. Other risks include:
- Bleeding
- Infection
- Wound gap
- Keloid scarring
- Redo or revision surgery
- Poor outcomes
- Inadequate removal
- Painful scar
- Mental health issue
It is important to consider the benefits and risks before undergoing the operation.
Outlook
Most patients have good outcomes after penoscrotal web repair. The operation restores the penoscrotal angle, reduces discomfort, and improves the appearance. Outcomes are generally satisfactory when performed by surgeons experienced in treating penile conditions.