Penile Adhesions & Skin Bridges

• A penile adhesion is where the skin of the penis or foreskin (when uncircumcised), sticks to the head of the penis.

  • Adhesions may resolve on their own or with minimal treatment.

• A penile skin bridge occurs when there is a number of adhesions that form and thicken, sticking to the head of the penis.

  • A skin bridge is often permanent and needs a minor surgical procedure.

The picture on the left is normal, the picture on the right is a foreskin bridge.

• When extra foreskin is left after a circumcision, it can cause adhesions and skin bridges.

• If extra fat develops in the pubic area, this can cause the foreskin to bury the penis and cause adhesions or skin bridges.

• In uncircumcised children, the foreskin should be more flexible as they grow so it can be retracted back.

  • If the foreskin cannot be pulled back, then adhesions and bridges can form.

• Sitting in wet or sticky diapers can cause adhesions to develop.

• Usually there are not any symptoms, as it usually doesn’t cause any pain or discomfort in babies and young children.

• Sometimes the overlapping of the foreskin becomes irritated or inflamed.

• The overlapping of the foreskin can trap the natural oils, body fluid and skin cells in the area.

  • The medical term for this collection of oils, fluids and skin cells is caused smegma.

  • When smegma is not cleaned regularly the foreskin may adhere to those areas.

• Sometimes as children age, there may be pain where the foreskin is attached, since the penis moves and pulls tightly on the foreskin.

• Your child’s primary healthcare provider will ask you some questions about your child’s symptoms.

• Your child’s primary healthcare provider will examine your child.

  • This examination is how your child will be diagnosed.

• For circumcised boys, after your child heals from their circumcision, gently retract the foreskin so that it does not stick to the head of the penis, but avoid forcefully pulling on it.

  • Try to do this with diaper changes after cleaning the area.

  • Doing this after a warm bath can make it easier as well.  

• Clean the area around the foreskin during each diaper change.

• Change diapers frequently, this helps your child from sitting in sticky diapers that can increase the risk of adhesions.

  • Diaper free time can be helpful.

For boys who are not circumcised:

• At birth, the foreskin is attached to the head of the penis (glans). It is attached by a layer of cells.

• Over time, the foreskin will separate from the head of the penis. This is a natural process and occurs over 5 to 10 years. It slowly loosens up (retracts) a little at a time.

• Normal erections during childhood cause most of the change by stretching the foreskin.

• If your boy has a normal urine stream, any foreskin movement is normal.

• There should be no rush to achieve full retraction. This always occurs on its own by puberty.

• Here is some care advice that should help.

  • Cleansing Before Age 1 Year:

    • During the early years of life, only clean the outside of the foreskin.

    • Don’t make any attempts at retraction.

    • Don’t put any cotton swabs into the opening.

  • Foreskin Partial Retraction:

    • Begin gentle partial retraction at 1-3 years of age. Exception: Your child’s healthcare provider has recommended not retracting foreskin until a later age.

    • Frequency: It can be done once per week during bathing.

    • Gently pull the skin on the shaft of the penis backward towards the stomach.

    • This will make the foreskin open up. You will be able to see part of the glans (head of the penis).

    • Be gentle. Retraction should never cause pain or crying.

  • Cleansing After 1 - 3 Years Old:

    • As the foreskin becomes able to partially retract, cleanse beneath it. This helps to prevent infections.

    • Wash the exposed part of the glans gently with warm water. Then, dry it.

    • Do not use soap or leave soapy water under the foreskin. This can cause redness and swelling.

    • Wipe away any whitish material (smegma) that you find there.

  • Reposition the Foreskin:

    • After cleansing, always pull the foreskin forward to its normal position.

  • Avoid Forceful Retraction:

    • This can cause bleeding or tears of the tissue.

    • It also may cause the foreskin to become stuck behind the penis head.

    • Retraction is too hard if it causes any pain or crying.

  • Teach Child How to Retract:

    • By age 5 or 6, teach your son to retract his own foreskin.

    • Teach him to clean beneath it once a week during bathing.

    • This will help to prevent poor hygiene and infection.

  • Pain Following Recent Attempt at Retraction:

    • The attempt to retract the foreskin has probably caused a small cut or tear. Raw surfaces are painful.

    • Cover the raw area with a layer of antibiotic ointment.

    • If you don’t have one, use petroleum jelly.

    • Once the raw surface is protected from the air, the pain should go away. The pain should slowly improve over a few hours.

    • Continue twice a day until healed. This takes about 1 or 2 days.

  • The No Retraction Approach to the Foreskin:

    • Some healthcare providers advise that a parent should never try to retract (pull back) the foreskin. The parent should never try to clean under the foreskin.

    • They teach that only the boy himself should ever retract his foreskin. They suggest teaching the boy to do this after puberty or about age 12.

    • They teach that the foreskin will naturally retract on its own during puberty. This is usually true.

    • The advice against parent retraction is more common in Europe.

    • It is a safe option and prevents any forceful or harmful retraction.

    • But, the gentle partial retraction for cleansing described with this advice is also safe.

    • Ask your child’s healthcare provider for their thoughts.

• Call your child’s primary healthcare provider if the foreskin looks red, attached, or seems to bother your child.

• Adhesions:

  • Some will resolve on their own overtime.

  • Clean the penis and foreskin well during each diaper change.

    • For circumcised boys, gently pull back on the foreskin during diaper changes and then apply petrolatum after cleaning.

  • After a warm bath, gently retract the foreskin.

  • Your child’s primary healthcare provider may prescribe a topical steroid to apply to the adhesion, if the foreskin is not loosening up on its own.

• Bridges:  

  • This requires a surgical procedure.

  • Your child’s primary healthcare provider will refer your child to a specialist, usually a pediatric urologist.

• You have concerns about your child’s foreskin or penis.

• You think your child has adhesions or a bridge.

• You have any other questions or concerns.

• You would like to have your child seen.