BRITISH JOURNAL OF UROLOGY, Vol 80, No. 5 (November 1997):
Pages 776-782.

Variability in penile appearance and penile findings: a prospective study.

R. S. Van Howe
Department of Pediatrics, Marshfield Clinic, Minoqua, Wisconsin, USA

[Abstract]
Objective  To Document prospectively variation in penile morphology
    and clinical findings in children.

Patients and methods  The study comprised a consecutive sample of 468
    boys whose consultation with a physician included a genital
    examination in a primary care paediatric practice in rural
    northern Wisconsin.

Results  Circumcised boys under 3 years of age were significantly more
    likely to have a partially or completely covered glans, a reddened
    meatus, balanitis, or trapped epithelial debris, and less likely
    to have a fully exposed glans than were circumcised boys of 3
    years or older.  Among the 238 boys under 3 years, those
    circumcised were significantly more likely to have non-cosmetic
    problems, including coronal adhesions, trapped epithelial debris,
    a reddened meatus, preputial stenosis (phimosis) and balanitis
    than were boys with a foreskin.  Findings in the circumcised group
    under 3 years included: fully exposed glans (n=78, 35.6%),
    partially covered glans (n=67, 30.6%), adhesions (25.6%),
    completely covered glans (20.1%), entrapped desquamated epithelial
    debris (24.7%), reddened meatus (19.1%), balanitis (15.5%), and
    preputial stenosis (0.9%). Only two genital examinations in boys
    with foreskins revealed pertinent findings. Coronal adhesions
    develop in circumcised boys at 2-6 months of age and usually
    resolve by 24 months.  The degree of skin covering the glans after
    neonatal circumcision peaks at 6 months of age.

Conclusions  There are significant variations of appearance in
    circumcised boys; clinical findings are much more common in these
    boys than previously reported in retrospective studies.  The
    circumcised penis requires more care than the intact penis during
    the first 3 years of life. Parents should be instructed to retract
    and clean any skin covering the glans in circumcised boys to
    prevent adhesions forming and debris for accumulating. Penile
    inflammation (balanitis) may be more common in circumcised boys;
    preputial stenosis (phimosis) affects circumcised boys and intact
    boys with equal frequency. The revision of circumcision for purely
    cosmetic reasons should be discouraged on both medical and ethical
    grounds.

Keywords  Penis, circumcision, abnormalities, phimosis, balanitis,
    adhesions

                  [Full text to be provided later]

_____________________________________
Accepted for publication 16 July 1997

Cite as:

Van Howe RS. Variability in penile appearance and penile findings: a
prospective study. Brit J Urol 1997;80:776-782.

(Abstract transcribed 7 November 1997)