Penis Abnormalities

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In most male infants the foreskin cannot be retracted over the head of the penis, this is not abnormal and is not a medical indication for circumcision, however, if over time the foreskin continues to be tight, particularly if it bulges during urination, is constantly irritated, or gets infected requiring antibiotics, a circumcision should be performed. Circumcisions at birth are mostly performed at parents’ request for cultural or religious reasons, not necessarily for medical reasons. We will perform office circumcisions on children less than three months of age at parents’ request.

Sometimes a child is born with abnormal-appearing penis that is bent (chordee) and does not have the opening at the tip, this condition is known as hypospadias and is often associated with hernias and undescended testicles. Operative repair of hypospadias uses the child’s own skin to build a tube in such manner that the opening of the penis is now at the tip, corrects the penile curvature and leaves the child circumcised. This is a delicate plastic surgery procedure of the penis that is performed with fine instruments and optical magnification. The ideal age for hypospadias repair is between 8-12 months. Some children have a webbed penis, a condition in which the skin from the shaft of the penis (sometimes even at the tip) extends to the scrotum, forming a band from the shaft to the scrotum. Repair of this condition involves releasing this web and creating a nice shaft of the penis that is free from the scrotum. Again, the ideal age for this type of repair is 8-12 months. Other children may have a concealed or buried penis, in which there are no attachments from the shaft to the overlying skin, so the penis may retract into the area of the pubis and it may appear even as if the child has no penis. Most, if not all of the children with buried penis, have a normal size penis and the operation to correct it involves bringing the penis out and securing the shaft skin at the base of the penis so that as the shaft skin heals it gets attached to the shaft of the penis, thus preventing the penis from sliding back into the pubis. This operation should be performed at about one year of age. Some children have a micropenis, a condition in which the penis is too small (two standard deviations below the norm), these children require a thorough evaluation by an endocrinologist ( a doctor that checks their hormone levels) and may need hormonal treatment.