Variations in Anatomy
Every child is different, and their penis and foreskin are also different. When parents arrange a circumcision for their son, they may have in mind that the child will look like the father, but this is definitely not often the case.
Some penises are long and skinny and others short and fat. Some bend to the left or to the right. Some fall back up the tummy. Some are bent, even to 90 degrees. This markedly bent penis is described as having a condition called Chordae and requires plastic surgery to straighten, and the foreskin is useful for this procedure, so should not be removed until the corrective surgery.
Hypospadius describes an anatomical variant where the urethral canal did not complete its development and did not close fully to the tip of the penis leaving a long opening along the underside of the penis. This also requires closure under general anaesthesia and the foreskin may be helpful for this purpose, so circumcision should not be done until the corrective surgery also.
The Disappearing Penis Syndrome
Many boys have loose attachment of the skin to the shaft of the penis. In these children, there may be a high insertion of the scrotal skin along the underside of the shaft of the penis, or there may be a pad of “puppy fat” in front of the pubic bone pushing the skin forward and away from the penis which is anchored at its internal base to the pubic bone. The penis appears to disappear behind the skin, and this is sometimes referred to as the “Disappearing Penis Syndrome”. It is also referred to as a “buried penis”.
It is primarily an issue of loose attachment of the skin and it is usual for the penis to “reappear” by the time the child is about 6 years of age, with the reduction in this puppy fat and the growth of the child. However, some few adults retain this appearance at rest; yet, it looks and performs perfectly adequately in sexual situations.
This anatomical variant, however, causes the parents concern after a circumcision, because as the skin moves forward over the head of the penis, it appears that not enough skin has been removed. This is not the case. The practitioner has to estimate the length of skin to leave in order that when the child is grown, there will be enough skin to cover the erect penis and not leave too much area that will be covered by scar tissue. It is only in the infant years, then, that the child may appear to have been inadequately circumcised.
It is very important in such boys, that the parents retract the cut foreskin regularly to prevent the cut edge healing and attaching to the head of the penis and creating a cosmetic result that is not desired. Therefore, if you notice that the skin of the penis is falling forward covering the head of the penis at any time after the operation, even up to a few years later, ( such that it looks like not enough skin was removed), then please have the child reviewed at the clinic. The doctor will explain to you how to manage the skin so as not to form permanent attachments to the head of the penis, and the doctor may have to separate the skin for you at times.