I was recently speaking with a urologist about “radical” circumcision, a procedure where pretty much all of the foreskin is removed from the penis. He told me that the removal of too much skin may lead to a condition called “buried penis.” I never heard of buried penis before, and I was intrigued, so I looked through the literature where I found a wonderful review on the subject titled “Management of ‘Buried’ Penis in Adulthood: An Overview” from the journal Plastic and Reconstructive Surgery. https://bit.ly/1HOaEj9
What is Buried Penis?
Fortunately, in adults, buried penis (also called hidden or trapped penis) is a rare condition. Often, the person with buried penis is morbidly obese. With buried penis, the suprapubic fat (fat directly above the penis) and the panniculus (layer of fatty tissue covering the lower abdomen) obstruct access to the genitalia. Keep in mind that when a person gains more fat, penis length is lost.
With the penis thus hidden, voiding urine (peeing) and developing an erection become difficult. Additionally, a person with buried penis often develops recurrent urinary tract infections, which otherwise are also rare in men. Not to mention that buried penis is difficult to bear from not only a medical perspective but also a psychological one, too. Obviously, it’s very disturbing to have limited access to your genitalia.
Causes of Buried Penis
Buried penis in the adult man is likely distinct from the congenital condition experienced by children. In adults, there are different causes of the condition:
- Injury from radical circumcision. With radical circumcision, a lot of foreskin is removed leaving little skin on the shaft and a scar closer to the abdomen. This scar can contract, and thus pull the penis into the suprapubic fat pad that is contiguous with the penis. (Regardless of weight, most men have a suprapubic fat pad.)
- Obesity. The panniculitis can drape over the penis creating an environment ripe for bacterial and fungal infection–especially if you have diabetes. Such infection damages and scars the skin. Lost skin and contracture of scar tissue pull the penis farther into the body.
- Genital lymphedema. Genital lyphedema or swelling can be due to various causes such as infection. Another cause of genital lymphedema is injection of viscous substances to help with erection and sexual performance.
Treatment for Buried Penis
Buried penis is notoriously difficult to treat, and there is little research on the topic. Even with diet and exercise, the fat surrounding the penis may be hard to lose. Part of the difficulty in understanding how to treat buried penis is lack of uniformity in how the condition is defined.
In terms of reconstruction, urologists usually team with plastic surgeons to treat the condition Surgical interventions can include:
- removal of diseased skin
- surgical removal of fatty tissue (lipectomy)
- creation of skin flaps
- skin grafting
Interestingly, the excess skin that develops during weight loss from bariatric surgery can drape over the penis and thus exacerbates conditions optimal for bacterial growth. So in and of itself, bariatric surgery isn’t a “fix” for buried penis.
Buried penis is a problem that will likely affect more Americans as time goes by. As you can probably imagine, most cases of buried penis are complicated by obesity. According to the CDC, more than a third of adults in the United States are obese (78.6 million people or about double the population of California). If you feel that you are having trouble peeing or having sex because its difficult to access your penis, it’s important to consult with a urologist or see a primary care physician and request a referral to a urologist.
If you feel that you may be at risk for buried penis, besides losing weight through diet and exercise, it may help to practice good bathroom hygiene and keep the skin surrounding your penis free of infection. Remember that despite harboring no bacteria, urine is a caustic chemical fluid that can damage skin. Try to avoid urinating on yourself by pulling back your foreskin and pushing the shaft of your penis down towards the center of the toilet bowl. If you do happen to pee on yourself, be sure to clean the skin after you’re done using the bathroom.
