Are you wondering where your baby boy's penis is? Does it look like a minuscule knob, or does it seem hidden in fat and skin? Your little boy could have what is known as a "buried penis." In this condition, the penis becomes “buried” beneath flesh and skin. It usually happens in infants.
What is a buried penis?
A buried penis is the partial or complete concealment of the penis beneath the scrotum or excess skin or fat in the genital area. Normally, the buried penis is normal in size and function. But in extreme cases, the shaft and head will not be visible at all.
Now, let's dig a little deeper into what's going on. Usually, a penis is wrapped in a sheath of skin. This skin is evenly distributed around the entire penis down to the scrotum.
However, some boys have skin that is unevenly distributed in the genital area when they were developing in the womb. It’s common in young babies, and is a congenital defect.
In most cases, this is more of a cosmetic issue than a medical one. However, having a buried penis can result in negative psychological effects later in life.
We should point out here that a buried penis should not be confused with a micropenis. The latter is just small even when stretched or erect, and is caused by structural or hormonal defects.
Causes of a buried penis
There are a few factors that contribute to a buried penis. Some of these causes are:
- Abnormalities present at birth (congenital): The ligaments that attach the penis to underlying structures may be weaker than usual.
- Morbid obesity: Excess fat around the abdomen and genital area can “bury” the penis inside fatty tissue and skin.
- Lymphedema: Swelling around the scrotum area due to the collection of lymph fluid may “bury” the penis inside fatty tissue and skin.
- Incorrect foreskin removal: Considering external factors, a buried penis can also occur when either too much or not enough of the penis’ foreskin is removed during circumcision.
Effects of a buried penis
Screen grab of a buried penis correction surgery, courtesy of YouTube user eldien muhammad shidqy.
Having a buried penis can complicate proper hygiene. When a baby pees, the foreskin may puff up and expand as it fills with urine. This can make the penis dribble urine constantly. Once it’s time for potty training, a baby with buried penis syndrome will have trouble directing his pee stream properly.
When an adolescent is diagnosed with buried penis syndrome, there are various health concerns that can affect him physically and psychologically. These may be any or all of the following:
- Pain or difficulty urinating (dysuria)
- Inflammation of the foreskin (balanitis)
- Trouble directing his urinary stream because of difficulty holding the penis, resulting in an inability to pee while standing or sitting
- Loss of proper urinary control results in difficulty with proper hygiene, as the pee will start to leak onto skin (scrotum and thighs) and clothes
- Urinary tract infection, genital infection
- Inability to get an erection or perform sexual acts
- Painful erections
- Embarrassment when naked in front other people
- Emotional distress, leading to psychological disorders like low self-esteem and depression
Apart from poor hygiene and the risk of urinary tract infection, a buried penis raises the risk of psychological and social trauma in children.
Obese boys with a buried penis will have severe body issues because of the correlation between excess fat and a buried penis. This psychological trauma may cause them to withdraw socially and have extremely low self-esteem. It may also lead into full-blown depression.
Correcting a buried penis
Surgery may relieve boys of their anxiety and improve their self-image. But parents are advised to encourage afflicted boys to lose weight first before going into surgery.
Diagnosing it is pretty easy. Penises are not supposed to fully retreat into pubic flesh, so no imaging or laboratory tests are necessary. What doctors will assess is the amount of skin available for use in surgery or redoing a circumcision.
Another factor they examine is how well the penis’ skin attaches to its deeper structures, and the angle at which the ligament attaches the penis to the body.
The only way to correct a buried penis is by surgery. Every operation will depend on the factors that have caused the child’s buried penis. Doctors may need to remove excess skin or improve the penis’ connection to its internal structure.
[Trigger warning: The following video of buried penis surgery you are about to see is extremely graphic in nature.]
However, if too much skin was removed during circumcision, doctors may need to do a skin graft — that is, putting a piece of healthy skin to "grow" on the penis.
Operations to correct a buried penis usually last between 60 and 90 minutes, depending on the case. The result of the operation will only be apparent about three to six weeks after the surgery.
If surgery isn’t an option, doctors can apply an anti-inflammatory medicine (like betamethasone) to the area. The patient can manually pull the foreskin several times a day.
As a warning to parents, if you’re going to have your baby circumcised, talk to your doctor first and have him/her examine if it’s safe for your child or not. Circumcising a child without examining his penis may lead to a buried penis if not done right.
Complications from the procedure
Though most of them are temporary, there are some complications that could occur after the corrective procedure:
- During the healing process, scar tissue inside the skin can sometimes stick together. These are called adhesions. Or, extra connective tissue called fibrosis can build up. Both can pull the penis back in again and bury it.
- Swelling of the penis
- Pain during erection
- Poor graft healing, flap necrosis or complaints of decreased sensitivity in the grafted area
- Persistent overgrowth of the skin covering the penis
- Belly fat re-accumulates
Pre- and post-operative Care
Photo courtesy of Science Direct
Babies and older children must fast right before surgery.
Also, don’t give your child Motrin, Advil, ibuprofen, or aspirin 14 days before the surgery. Tylenol or acetaminophen is okay to use.
Inform your doctor of any symptoms of illness (like a fever, rash, or cold) if they appear a week before the surgery. This is important as an illness may affect the outcome of the surgery.
On the day of the surgery
Your doctor or his/her staff will give you information on what your child can eat or drink before surgery. Be sure to understand the instructions and follow them to the letter. The doctor may cancel or delay the surgery if you don’t follow the instructions or the schedule.
What to bring for your child:
- Pacifier or special blanket to help comfort your child
- Change of loose clothes for your child to wear home
What to expect
Your baby's penis will tend to bleed a tiny bit around the bandage. There may be a lot of swelling and the penis will get red and look puffy. Now, don't panic. This is normal.
If the dressing falls off, that's okay, too. You don't need to apply a new one or call the doctor. The Phoenix Children's Hospital recommends that you put your child in a bathtub on the third day after surgery so the bandage can get wet, making it easier to remove. If you're still having difficulty removing it, apply liberal amounts of baby oil to loosen the adhesive.
Once you remove the bandage, you'll need to apply petroleum jelly on the penis every diaper change, or three to four times a day (if the baby is not in diapers). This is to prevent the shaft of skin from attaching to the penis head.
You'll need to pull back the shaft skin to see the ridge of the penis head. This promotes healing and prevents the shaft skin from reattaching to the penis head.
For babies, plain Tylenol is adequate for pain relief. If your child is over six months old, he can take ibuprofen, Advil, or Motrin. Ask your doctor to prescribe a pain reliever, which maybe given every six hours as needed.
For the first two days after surgery, your baby can only do sponge baths. After the dressing has been removed, he can take normal baths again. Put a limit of 5-10 minutes at a time in the tub during the first week after surgery.
Just start your baby on clear liquids (breastmilk, water, apple juice). If your child tolerates this well, he may begin regular diet by the evening after surgery.
Be warned that your child will experience nausea and vomiting after anaesthesia. If this occurs, do not feed your child for one to two hours. Afterwards, you can begin with clear liquids.
Limit your child's physical activities for two weeks in the following:
- tricycle or bicycle riding
- jungle gym
- playground equipment
- straddle/ride-on toys
Swimming is especially risky since your child may get an infection from the pool water.
After two weeks or once he heals properly, he may resume normal activities. Going back to school or day care will depend on your child's age and the adequacy of supervision upon his return.
Treat it early
In a review of the phenomenon, a study by the Changhua Christian Hospital in Taiwan suggests that a buried penis should be corrected immediately after the affected child starts walking, when their abdominal fat has diminished. But some experts correct the anomaly immediately after diagnosis to resolve medical and cosmetic problems in children.
The review adds that surgical corrections are more successful in toddlers than in adolescents. It explains that as the penis length increases, the groin fat accumulates, making surgical corrections in adults more difficult.
That’s why a buried penis’ accurate diagnosis and an early referral by a primary care physician is important. A satisfactory treatment is only achieved with proper surgical management in young boys or infants.
Sources: Cleveland Clinic, Science Direct, About Kids Health, Children's Hospital of Chicago, Phoenix Children's Hospital, Children's Hospital of Orange County
YOU CAN ALSO READ: Newborn baby boy circumcision: What it is, aftercare and more
Republished with permission from: theAsianParent Singapore