Buried Penis: A Comprehensive Overview

Introduction

The buried penis disease condition, though relatively uncommon, has significant implications for both physical and psychological well-being. This condition, also referred to as “concealed penis”, is characterised by the partial or complete obscuration of the penis beneath the surrounding skin or tissue, making it difficult to visualise or access the organ despite its normal anatomical structure. Affecting individuals across age groups, it is particularly significant in paediatric populations and adults with certain risk factors.

Understanding the Normal Penile Structure

To appreciate the complexities of the buried penis condition, it is essential to first understand normal penile anatomy. The penis is composed of three main columns of erectile tissue: two corpora cavernosa and one corpus spongiosum, which houses the urethra. Externally, it is enveloped by skin and subcutaneous tissue, with the penile shaft extending from the pubic bone to the glans. The penile skin is normally loose and mobile, allowing for changes in length and size during erection and flaccidity.

The base of the penis is anchored to the pubic symphysis by the suspensory ligament, and the overlying skin is supported by connective tissue. In healthy individuals, this anatomical configuration ensures that the penis is visible and accessible. Any disruption or alteration in the relationship between the skin, subcutaneous tissue, and underlying anatomy may contribute to the development of a buried penis.

Definition and Overview of Buried Penis

Buried penis is a medical condition in which the penile shaft is partially or completely hidden beneath the skin of the abdomen, thigh, or scrotum. The penis itself is usually of normal size and structure, but it is not externally visible or is only partially visible. This can occur at birth (congenital) or develop later in life (acquired). The condition should not be confused with micropenis, where the penile length is genuinely reduced. Instead, the buried penis is present but concealed by the surrounding tissues.

The significance of this condition goes beyond cosmetic concerns. It can interfere with urination, sexual function, hygiene, and psychological health. In children, it may lead to social embarrassment and difficulty with toilet training, while in adults, it often results in sexual dysfunction and distress.

Epidemiology and Significance

Buried penis is relatively rare, but its prevalence is increasing, particularly in populations with rising rates of obesity. It can affect males of any age, from infants to the elderly. The condition is more commonly reported in paediatric urology clinics, but cases among obese adult men are becoming more frequent. The true incidence may be underestimated due to social stigma and reluctance to seek medical attention.

Causes and Risk Factors

The aetiology of buried penis can be broadly classified into congenital and acquired causes, with several risk factors contributing to its development.

Congenital Causes

• Abnormal Attachment of Penile Skin: In some infants, the penile skin may be abnormally attached to the shaft or pubic area, leading to concealment of the penis.
• Underdeveloped Suspensory Ligament: Weakness or malformation of the ligament that anchors the penis can allow it to retract into the surrounding tissue.
• Excessive Prepubic Fat: Some children are born with increased fat in the pubic region, which can envelop the penis.

Acquired Causes

• Obesity: Excessive accumulation of fat in the suprapubic region is the most common cause in adults. The fat pad pushes the penile shaft inward, making it less visible.
• Scarring and Fibrosis: Following trauma, infections (such as balanitis), or surgical procedures (like circumcision), scarring can tether the penile shaft, pulling it inward.
• Lichen Sclerosus and Other Skin Diseases: Chronic inflammatory skin conditions can lead to contracture and concealment of the penis.
• Penile Lymphedema: Swelling due to lymphatic obstruction can cause the skin to envelop the shaft.
• Penoscrotal Webbing: Abnormal fusion or webbing between the scrotum and penis can contribute to the buried appearance.
• Age-related Changes: Loss of skin elasticity and changes in fat distribution in the elderly may predispose to the condition.

Risk Factors

• Obesity (including childhood obesity)
• Previous penile or genital surgery
• Chronic infections or inflammatory skin disorders
• Trauma to the genital region
• Poor hygiene or chronic irritation
• Genetic predisposition

Clinical Presentation

The presentation of buried penis varies depending on age, underlying cause, and duration of the condition. The most common and distressing feature is the inability to visualise the penile shaft, with only the glans or sometimes no part of the penis being visible externally.

Signs and Symptoms

• Difficulty with Urination: Patients may struggle to direct the urinary stream, leading to spraying, dribbling, or incontinence. In severe cases, urine may become trapped, increasing the risk of infections.
• Recurrent Infections: Poor exposure of the penis makes hygiene difficult, predisposing to balanitis (inflammation of the glans) and urinary tract infections.
• Sexual Dysfunction: In adults, buried penis can cause erectile dysfunction, pain during intercourse, and difficulty with penetration.
• Pain and Discomfort: The concealed penis may be prone to irritation, maceration, and secondary infections.
• Psychological Distress: Embarrassment, low self-esteem, and anxiety are common, especially in adolescents and adults.
• Difficulty with Hygiene: Cleaning the area becomes challenging, increasing the risk of odour and infections.
• Social and Developmental Issues: In children, the condition may interfere with toilet training and socialisation.

Impact on Quality of Life

The impact of a buried penis extends beyond physical symptoms. Many patients experience significant psychological and social distress. Issues related to body image, sexual identity, and interpersonal relationships are frequently reported. Children may face bullying or teasing, while adults may avoid intimacy due to embarrassment.

Diagnosis

Diagnosing buried penis is primarily clinical, based on a thorough history and physical examination. Early recognition and assessment are crucial to prevent complications and initiate appropriate management.

Physical Examination

• Inspection of the genital region to assess the visibility of the penile shaft
• Palpation to determine the size and position of the penis beneath the skin
• Assessment for associated findings such as scarring, oedema, or signs of infection
• Evaluation of the pubic fat pad and suspensory ligament

Imaging Studies

• Ultrasound: May be used to evaluate underlying penile structures and differentiate from other conditions such as micropenis or penile agenesis.
• MRI or CT Scan: Rarely needed, but may be considered in complex or recurrent cases.

Differential Diagnosis

• Micropenis (true reduction in penile length)
• Penile agenesis (complete absence of the penis, extremely rare)
• Penoscrotal webbing
• Severe phimosis (tight foreskin)

When to Seek Medical Help

Medical consultation is warranted if a patient or caregiver notices persistent concealment of the penis, difficulty with urination, recurrent infections, or psychological distress. Early referral to a urologist or paediatric surgeon is recommended for timely intervention.

Treatment Options

Management of buried penis depends on the underlying cause, severity, patient age, and associated complications. A multidisciplinary approach involving urologists, plastic surgeons, paediatricians, and psychologists is often beneficial.

Conservative Management

• Weight Reduction: In obese patients, gradual weight loss can significantly improve the visibility of the penis by reducing the suprapubic fat pad.
• Optimising Hygiene: Regular cleaning and use of barrier creams may prevent infections and irritation.
• Treatment of Infections: Topical or oral antibiotics and antifungals as indicated.
• Counselling and Psychological Support: Addressing body image concerns and emotional distress is crucial, especially in children and adolescents.

Surgical Interventions

• Release of Penile Skin: Surgical freeing of the penile shaft from surrounding tissue and re-anchoring to the pubic area.
• Excision of Excess Fat or Skin: Removal of suprapubic fat pad (panniculectomy) or redundant skin to enhance penile exposure.
• Reconstruction of Suspensory Ligament: Strengthening or repositioning the ligament for better support.
• Correction of Scarring: Removal of fibrotic tissue and resurfacing with skin grafts if needed.
• Repair of Penoscrotal Webbing: Surgical separation of fused tissues.
• Adjunctive Procedures: Circumcision or lysis of adhesions as indicated.

Surgical management requires careful patient selection and pre-operative counselling regarding expectations, risks, and post-operative care.

Post-operative Care and Patient Counselling

• Wound care and infection prevention
• Pain management
• Monitoring for complications such as bleeding, infection, or recurrence
• Gradual resumption of normal activities and sexual function
• Psychological support to address emotional adjustment

Complications

If left untreated, or in cases of delayed diagnosis, buried penis can lead to several physical, psychological, and social complications:

• Recurrent Infections: Increased risk of balanitis, cellulitis, and urinary tract infections due to poor hygiene.
• Skin Breakdown and Ulceration: Maceration of skin can lead to sores and non-healing wounds.
• Voiding Dysfunction: Chronic difficulty with urination can result in urinary retention or incontinence.
• Sexual Dysfunction: Erectile dysfunction, pain, and inability to engage in intercourse.
• Psychological Issues: Depression, anxiety, and social withdrawal.
• Impaired Quality of Life: Negative impact on relationships, self-esteem, and daily activities.
• Recurrence: The condition can recur, particularly if underlying risk factors like obesity are not addressed.

Prognosis

The prognosis for individuals with buried penis largely depends on the underlying cause and timeliness of intervention. With appropriate treatment—whether conservative or surgical—most patients experience significant improvement in both functional and psychological outcomes. Children who undergo early correction generally have excellent long-term results, while adults may require more complex interventions but can still achieve satisfactory outcomes.

Recurrence is possible, particularly if risk factors such as obesity are not controlled. Ongoing follow-up and lifestyle modification are essential for long-term success. Psychological support is vital to address any residual emotional issues and to aid in the adjustment process.

Prevention Strategies

Prevention of buried penis involves addressing modifiable risk factors and promoting early recognition and intervention.

Lifestyle Modifications

• Weight Management: Maintaining a healthy body weight through balanced diet and regular physical activity is the most effective preventive measure, especially in children and adults at risk of obesity.
• Good Hygiene: Regular cleaning of the genital area to prevent infections and skin conditions.
• Management of Skin Disorders: Early treatment of conditions like lichen sclerosus to prevent scarring.

Early Intervention

• Prompt medical attention for any genital abnormalities in infants and children
• Early treatment of infections and inflammatory conditions
• Careful surgical technique during circumcision and other genital procedures to minimise scarring

Awareness and Education

• Encouraging regular health check-ups and early consultation with healthcare professionals
• Educating parents, caregivers, and patients about the signs and symptoms of buried penis
• Promoting open communication regarding genital health to reduce stigma

Nursing Care of a Patient with Buried Penis

Nursing Interventions

1. Hygiene Maintenance

• Assist the patient in proper perineal hygiene. Use mild soap and water to cleanse the area, and ensure it is dried thoroughly to prevent fungal or bacterial infections.
• Educate the patient and family members (if appropriate) on the importance of daily hygiene and how to perform it safely.
• Apply barrier creams or powders as prescribed to reduce moisture and skin breakdown.

2. Skin Integrity

• Inspect the skin regularly for redness, excoriation, ulceration, or signs of infection.
• Encourage the use of absorbent pads or cotton undergarments to keep the area dry.
• Reposition the patient regularly if mobility is restricted to prevent pressure injuries.

3. Infection Prevention

• Monitor for signs of local or systemic infection: fever, increased redness, swelling, foul odour, or discharge.
• Follow strict aseptic technique during dressing changes if there are wounds or post-surgical incisions.
• Administer antibiotics as prescribed and monitor for side effects.

4. Urinary Care

• Monitor urine output and assess for difficulty in voiding, dribbling, or retention.
• Assist with positioning during urination to facilitate complete bladder emptying.
• Teach the patient to recognise symptoms of urinary tract infection and report them promptly.

5. Nutritional Support

• Encourage a balanced diet rich in proteins, vitamins, and minerals to promote wound healing and immune function.
• If obesity is a contributing factor, collaborate with a dietician to develop a weight reduction plan.

6. Psychological Support

• Provide a non-judgemental and empathetic environment for the patient to express feelings and concerns.
• Offer counselling or refer to a mental health professional if necessary to address body image or sexual health issues.
• Involve family members in care and education, respecting the patient’s privacy and preferences.

7. Patient and Family Education

• Educate about the nature of the condition, possible treatments, and the importance of adherence to care recommendations.
• Demonstrate proper techniques for hygiene and skin care.
• Discuss the importance of follow-up appointments and monitoring for complications.

Postoperative Care (if Surgical Intervention is Done)

• Monitor the surgical site for bleeding, infection, or dehiscence.
• Provide pain management as prescribed.
• Support mobility as tolerated and encourage early ambulation if possible.
• Educate on wound care, signs of complications, and activity restrictions.

REFERENCES

1. Cavayero CT, Cooper MA, Harlin SL. Adult-Acquired Hidden Penis in Obese Patients: A Critical Survey of the Literature. https://pubmed.ncbi.nlm.nih.gov/25722361/. J Am Osteopath Assoc. 2015;115(3):150-156.
2. Chin TW. Buried Penis  https://www.sciencedirect.com/science/article/pii/S1682606X16300445. Formos J Surg. 2016 Aug;49(4):133-135.
3. Cohen PR. Adult Acquired Buried Penis: A Hidden Problem in Obese Me.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932830/. Cureus. 2021 Feb 1;13(2):e13067.
4. Anandan L, Mohammed A. Surgical management of buried penis in adults. Cent European J Urol. 2018;71(3):346-352. doi: 10.5173/ceju.2018.1676. Epub 2018 Sep 22.
5. Ho TS, Gelman J. Evaluation and Management of Adult Acquired Buried Penis.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127540/. Transl Androl Urol. 2018 Aug;7(4):618-627.
6. Staniorski CJ, Rusilko PJ. The Concealed Morbidity of Buried Penis: A Narrative Review of Our Progress in Understanding Adult-Acquired Buried Penis as a Surgical Condition (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261441/). Transl Androl Urol. 2021 Jun;10(6):2536-2543.
7. Ho TS, Gelman J. Evaluation and management of adult acquired buried penis. Transl Androl Urol. 2018 Aug;7(4):618-627.

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.