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Penile Adhesions Treatments

At his recent 9 month check-up, my pediatrician informed me that my son has penile adhesions. She said we should pull back the foreskin each night after a bath and apply 1% hydrocortisone cream. After examining his penis more closely and doing more reading on this topic, I am very concerned and confused about the proper way to proceed. It looks like the foreskin has re-attached all the way around his penis. Therefore, it seems that it will take a good bit of pulling in order to fix it. At the same time, I have read conflicting information online about how best to treat adhesions. Some people say they will resolve themselves over time and as he grows. Others say that fixing it sooner rather than later is important. And I’ve even read that pulling back the foreskin continually will cause scarring and problems later on.

Help! I want to resolve this in a way that is most effective and least painful for my son

I’m sorry to hear about your son’s adhesions. Penile adhesions are a very common (although unspoken of) issue. Even as a doctor the answers on this issue is unclear. I do not believe penile adhesions were discussed during my training. This issue became important to me when shortly after my residency one on my boys developed mild adhesions. Now, I try to mention adhesions as a complication prior to circumcision and discuss preventative retraction at the 2 week or 2 month visit.

Certainly, trying a steroid cream is a great option. I’m uncertain of any data surrounding 1% hydrocortisone cream, but doubt it would be harmful. A stronger prescription steroid cream, betamethasone ointment works 50 to 70 percent of the time. This treatment takes advantage of a known side effect of steroid creams, thinning of the skin. A local pediatric urologist had recommended treating with betamethasone ointment twice a day for one month, taking a month off and then treating for second month
.

I’m more in the camp that fixing it now is better than waiting to see if it resolves. It makes sense to me that the longer the area remains connected the stronger the tissue will adhere. Most penile adhesions are quickly resolved with manual separation and then good local care. Manual separation typically causes minimal pain and crying (less than with a vaccine). Local care should include at least daily retraction and petroleum jelly if there is redness and irritation.

Some penile adhesion cannot be easily manually reduced. These are often “band” type adhesions. For these I usually recommend the previously mentioned betamethasone treatment. Unfortunately, many of the “band” type end up requiring surgical intervention. This seems to go better after the steroid cream therapy even when it does not break the band as it often thins it out.

General information - penile adhesions
See a series of sketches pictures of penile adhesions
More on preventive care - penile adhesion care

Written August, 2010 by
Dr. Gordon, Orlando Pediatrician

 

 

 

 

 

 

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