Penile synechia, circumcision revision contemplated

Dear Dr. Reed,

I was circumcised when I was 14 years old. The Dr. left me with this. I was looking for some information/opinions on whether or not there is anything I could do about it and what that would entail.  Thanks

Steve

Dear Steve

From your photos I am looking at a wonderful penis and scrotum. Your penis may have a slight upward curvature if one of these photos is taken when erect. If not a problem for you, nothing need be done.

You have synechia or an adhesion of shaft type or epidermal skin to the glans of your penis. We see this frequently in situations of phimosis where chronic inflammation causes an adherence of the inner to outer layer. In your situation, mostly likely an inadequate amount of skin was removed or the synechia were never properly separated in the first place. There is a probe with a rounded tip just for this purpose for neonatal circs and can still be use for adult circs or gentle undermining with a spreading technique will often do.

Underneath there is nacent glans epithelium usually, which although may appear raw will usually regenerate to mature glans epithelium in 4 to 6 weeks. “If you tell nature what you expect of it, and try to help out, nature will understand and do the rest.” The extra distal shaft skin of course has to be removed so that there is no longer a possibility of “re-coverage” when you are flaccid.

After separation we do recommend use of an antibiotic ointment to keep the area moist (not so much because I believe this will recur in that now there is no extra skin to lay over). Moist wounds heal better than dry wounds.

We see patients like you about once every 2 weeks in the office (35 plus years of experience) and so far everyone has done well.
Please provide a followup.

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America
International Society for Sexual Medicine
WPATH

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