Penile Adhesions: What They Are & How to Deal With Them

09/16/2011

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You've heard of penile adhesions following circumcision, but how should they be properly taken care of? 

Adhesions (or skin bridges) are the result of two raw tissues healing together. With circumcision, the cut skin will try to heal back and can possibly attach itself to the penis, creating a skin bridge. This is why some doctors recommend putting Vaseline on the glans for a week to ten days after circumcision (which will prevent the two structures from reattaching.) But what happens if this doesn't work and adhesions form?

It is likely that your doctor will advise you to rip the tissues apart, which can cause pain, bleeding, and scarring. It may be best to see what his reaction is before attempting to do this. If it's painful and traumatic for him, it would be best to leave it alone for now. We're learning that adhesions can sometimes resolve themselves as the boy approaches puberty and begins to 'fiddle' with his penis. In boys that are not circumcised, the foreskin will start to separate as the boy pulls on his foreskin (boys pull the foreskin out and away from their bodies, not toward their bodies.)  Note: only the boy himself should be the one pulling. Everyone else (doctors, parents, etc.) need to leave it alone.

If the adhesions do not resolve on their own by the time the boy approaches puberty, topical creams can be prescribed which will weaken the tissue and help break down the adhesions. If the topical creams do not work, the adhesions can be lysed after the boy goes through puberty (18-25 years) when his penis is done developing. At that time, he will also be able to understand what is happening to his body and can have proper pain medication. Of course, if problems develop prior to puberty, they would have to be dealt with when they present themselves.

The important thing to remember is: adhesions do not need to be immediately dealt with in young children or forcefully ripped apart. As said before, it is possible that the adhesions can resolve themselves. Do not feel pressured by anyone, even your doctor, to take immediate action. If needed, get a second opinion from an intact-friendly doctor first.
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Pressure from Spouses: A Botched Circumcision Leads to Regret

09/07/2011

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A mother shares about the pressure she received from her spouse, and how her son's botched circumcision caused her to regret going against her instincts. 
Posted with Permission from Author

When I found out my second child was a boy, I started immediately thinking of the differences I would find in parenting and care-taking between him and my first born daughter. As I sat at lunch one day with my sister and mother, my sister asked me if I planned on circumcision. We sat there talking and she informed me if she could go back, she wouldn’t do it to my nephew. My mother agreed, stating that if she had had the choice all those years ago, she doesn’t think she would have done it to my three brothers. I was unsure, however; I don’t have a penis, never had to care for one, never knew anything different than circumcision. But I was young. The world was changing. So I did what any reasonable young mother would do. I researched.

I googled everything I could think of, day and night. I watched videos, read articles, looked up scientific facts on pros and cons. I blogged and tweeted my concerns, asking for help making this decision from friends, family, and even strangers. In my heart I knew it was wrong, I couldn’t find any reason to justify it, but I also struggled finding a reason to justify not doing it to my husband. He was convinced it had to be done, that it was cleaner, that it was easier to care for, that it was the natural thing to do. My son would look different than his peers, he would look different than his father, and women wouldn’t be attracted to it. I tried to show him the research, I tried to discuss it, I tried to show him the videos, but to no avail. I couldn’t convince him and I was tired of fighting. Finally, someone gave me this advice, “If you’re still unsure and it’s that important to your husband, just let him decide, even if you don’t agree on it.” So I did. I relented and said, “Fine, dear, have it your way.”

The days and weeks leading up to the birth of our son, I still tried, without luck, to make my husband reconsider. Not even reconsider really, but to just consider another option. He wouldn't watch the videos and stated plainly that I had no idea what owning and cleaning a penis entailed; it would be much more difficult if he was left intact. Did I really want that?

My son was born early on a July morning, and by the afternoon the nurse came around to ask if we were choosing circumcision. I was alone in the hospital room at this point and nearly told her no, to leave him alone, but instead I choked out a yes and was told that he would be picked up tomorrow morning for his “procedure.”

The next day, I sat; silently praying they wouldn’t show up, that they would forget about us, about him, about his penis. They allowed me to finish nursing while they described the way it would happen, what they would do to soothe him and had me sign the forms with a shaky signature. They promised it wouldn’t be more than an hour- two tops. He would come back, right as rain.

I sobbed as they wheeled his little bed away from me.

Five hours later, I awoke from a nap to my husband standing in the room, questioning where he was. I didn’t know, they took him away this morning and I hadn’t seen him since. He walked to the nursery to question the nurses where they explained that he had bled “just a little more” than they were comfortable with, so they kept him a little longer just to make sure.

“You’re lucky!” The nurse laughed at my husband. “Most babies are way too small and the doctors have a lot of trouble getting the whole thing off. You have a big boy!”

For days, my son slept. Not the sweet, peaceful sleep of a newborn, but a fitful, obviously painful sleep. When he awoke, he screamed in pain, unable to be soothed, unwilling to nurse or cuddled closely. He screamed when he urinated or defecated; he was only happy when his diaper was off, but so long as his penis went untouched. I lived in fear of diaper changes. I wanted nothing more than to just leave him be; no diaper, no pulling his penis to ensure the foreskin wouldn’t grow back, no Vaseline on the base. Just freedom from pain is all I wanted for him. We both sobbed during those moments, his diapers always speckled with blood and his face always tear stained.

The healing process never seemed to end. As he got older, the bleeding stopped, but the wound never healed. At first, his pediatrician told us to continue to just put the Vaseline on it, continuing to treat it like we always had. It wasn’t until six months of questioning did she inspect a little better and found that, while the doctors considered him a “big” boy and claimed to have no trouble with his circumcision, they actually snipped too much off. Now, he will have a permanent scar about a half of an inch long at the tip of his penis. When it will become a scar, I have no idea (as of right now, it’s still an open wound, 14 months later.) We’re still required to keep Vaseline on it several times a week. We find blood occasionally on diapers and hear him screaming at the first sign of a dirty diaper. He runs away after his diaper comes off and holds himself sobbing. During those nights when his cut reopens, he and I both lay awake at night crying, wishing for an end.

We should have allowed him that choice, we should have waited. If we had, he wouldn’t be in pain several times a month... he would be whole with no pain, as he should be. I don’t know if this has changed my husband’s view on circumcision, and I don’t blame him for this. I blame myself for saying yes; I blame myself for signing those forms; I blame myself completely, and I will fight for tomorrow’s sons- whether they are my own, my nephews, or a stranger's. No boy should have to go through this pain, not for his parents peace of mind.

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Proper Care of the Intact Penis (From Baby to Teenager)

09/03/2011

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A closer look at the care of the intact penis and proper hygiene as he grows older.

The male foreskin is fused to the head of the penis at birth (just like the female foreskin- the clitoral hood- is normally fused to the glans of infant and young preadolescent girls). This is the body's way of protecting the genitals against urine and feces. Because it is fused shut, bacteria and other foreign particles cannot invade. 

It is absolutely unnecessary to forcibly retract the foreskin to clean under it, and in fact- this will cause bleeding, scarring, and damage to the penis. Pulling it back before it is ready can also introduce foreign bacteria which can lead to infection.

The first person to retract a boy's foreskin should be the boy himself. Everyone else- hands off. The average age for this to happen is about 10 years old. About that time, the foreskin will start to become detached (although sometimes it is sooner, and sometimes it is later). Until about puberty, the body isn't producing anything that needs to be 'rinsed'. So if he gets especially dirty, sitting in a warm water bath (without soap) should take care of the cleaning. Once he can retract his own foreskin, he just needs to pull it back during a shower, rinse with warm water, and return it to the original position. No soap & no scrubbing under the foreskin.

Occasionally, parents might notice the tip of the foreskin being red or inflamed. Don't worry! This is common, and depending on the cause, can resolve itself very quickly. Please read this article on red foreskins in children to get more information.

If child has been forcefully retracted, the best thing to do is stop retracting and let it heal. Please click here to get more information on what to do now and how to clean. Putting a boy into the bath several times a day helps. The body, air, and water are the best healers. Of course, you must be vigilant about watching for infection beyond the initial inflammation for the first week following forcible retraction.
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