Buried Penis: Physical Condition, Psychological Complications

Introduction

A buried penis may be caused due to abnormalities in the penis ligament, obesity, or swelling. It can lead to physical and psychological problems. Therefore, the treatment is mainly by a surgical approach.

What Is a Buried Penis?

A buried penis is seen in younger boys and adult men. The penis is often of normal size but is found hidden under the skin of the abdomen, scrotum, or thigh. It is a congenital disorder in which a penis of normal size is deficient in the sheath of skin and is presently hidden below the integument of the abdomen, scrotum, or thigh. This condition is common in neonates or obese perpetual boys and circumcised and uncircumcised individuals. However, the cases may not be diagnosed until childhood.

What Causes a Buried Penis?

It is a condition that can be present at birth or may develop later in life. It is more common in infants and toddlers than in older boys and men. The most common causes include the following:

• Abnormalities Present at Birth: The ligaments attaching the penis to underlying structures may be abnormal or weak.

• Class III Obesity: The presence of too much fat around the abdomen and genital area makes the penis appear hidden or buried.

• Lymphedema: There may be swelling around the scrotum caused by the collection of lymph fluid that makes the penis appear buried inside the tissue.

What Are the Complications of a Buried Penis?

A buried or hidden penis often has physical and psychological problems, which include the following:

• Men or boys may find it difficult to urinate without spilling urine on the skin of the thighs, scrotum, or clothes.

• Infections are common in the genital area and urinary tract due to constantly moist skin.

• In uncircumscribed individuals, the skin of the head of the penis may become inflamed.

• Individuals may be unable to get an erection. They may have painful vaginal sexual intercourse.

• Psychological problems linked to a buried penis may be present in affected individuals. For example, they may face issues like low self-esteem and depression.

What Are the Other Conditions Seen in Association With a Buried Penis?

The other conditions that are taken into consideration include the following:

• Trapped Penis: Trapped penis is a condition in which the penis is unnoticeable secondary to a cicatricial scar, usually after a circumcision.

• Webbed Penis: Webbed penis is an obscuration (concealing) of the penile shaft by scrotal skin at the penoscrotal junction.

• Micropenis: Also known as microphallus, a penis measuring less than two standard deviations below the mean length when measured in the stretched state.

• Diminutive Penis: Diminutive penis is a small, malformed, or both seen secondary to epispadias (an uncommon birth defect located in the urethral opening), extropy, chromosomal abnormalities, severe hypospadias, or intersex conditions.

What Is the Clinical Presentation of a Buried Penis?

Buried penis is common among the age groups of six months to one year. Adolescents who present with a buried penis are mostly obese, and weight loss is recommended. Individuals may be circumscribed or uncircumcised, and repair is complicated in circumcised individuals. Therefore, the clinical presentation may vary. Often parents are concerned because they cannot see the penis, which may lead to poor hygiene. Occasionally, there may be ballooning of the skin with voiding, and children may be constantly wet.

Adolescents may present with dysuria (discomfort or pain while passing urine), dribbling between the voids, and difficulty directing their urinating stream because of the inability to hold the penis or face embarrassment in the peer group. In addition, some individuals have a history of balanoposthitis (inflammation of the foreskin and the penile head) and balanitis (swelling of the foreskin and penis head), and some have undergone a radical circumcision or multiple circumcisions.

Adults may have sexual complaints, which include painful erection, difficulty in vaginal penetration, sexual embarrassment, and the tip of the glans that does not project beyond the escutcheon. This leads to the inability to void in a standing. Diabetes (a metabolic condition that results in high blood sugar levels) and obesity are commonly associated comorbidities.

How Is a Buried Penis Examined?

During a physical examination, the individual is made to lie down in a supine position. And the physician examines the penis. The penis is buried and enclosed in scrotal tissue called a penis palmatus. It is further trapped by phimosis, traumatic scar tissue, or is hidden secondary to a large hydrocele or hernia. A smooth transition of prepubic skin to penile skin indicates a buried penis. A trapped penis has a groove at the base of the penis.

How Is a Buried Penis Treated?

The treatment involves the following:

Medical Care:

The separate association of the buried penis, which is the trapped penis seen secondary to neonatal circumcision, is treated with topical Betamethasone and manual retraction.

Surgical Approach:

Various techniques have been described for repairing buried penis. The techniques vary depending on the etiology to simplify the procedure. In addition, there may be possibilities of recurrence and the need for subsequent procedures.

A buried penis can be hard to treat in both children and adults. In children and infants, there are chances the condition may go away on its own. However, surgery may be required if it occurs in adults or does not resolve independently. The types of surgery may include:

• Removal of scar tissue.

• Detaching or removing the ligament attached to the base of the penis and the pubic bone.

• Suction lipectomy or removing fat cells using surgical catheters inserted through tiny incisions.

• Abdominoplasty may be done to remove surplus fat and skin from the abdomen, also called the “tummy tuck” procedure.

• Panniculectomy removes the pannus (the excess tissue hanging down over the thighs or the genitals).

• Escutheonectomy is the removal of the fat pad present above the pubic area.

• Skin grafts may be used to cover areas of the penis where skin coverage is missing.

• Buried penis repair is done where sutures are placed internally on the floor of the penis.

• A buried penis can also be treated with weight loss. Individuals with obesity usually are advised to lose weight before having surgery. Although weight loss is not the only solution, it can reduce complications during surgery.

Conclusion:

A buried penis is a penis that is often of normal size but is found hidden under the skin of the abdomen, scrotum, or thigh. It can affect children or adults. Treatment is usually surgical management. In addition, individuals may be advised psychological counseling to address sexual dysfunction, depression, and low self-esteem.