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'''{{FULLPAGENAME}}''' are both connections that can exist between the [[glans penis]] and the [[skin]] of the [[penis]]. The fusion is normal and healthy, while the adhesion is an abnormal, pathological condition that is usually a complication of [[circumcision]]. The two separate, diverse conditions are frequently confused, both by the public and by health care providers.
'''{{FULLPAGENAME}}''' are both connections that can exist between the [[glans penis]] and the [[skin]] of the [[penis]]. The fusion is normal and healthy, while the adhesion is an abnormal, pathological condition that is usually a complication of [[circumcision]]. The two separate, diverse conditions are frequently confused, both by the public and by health care providers.


==Fusion==
==Fusion==
It is well established that boys are born with the inner [[foreskin]] fused with the underlying [[glans penis]] by a [[synechia]].
It is well established that boys are born with the inner [[foreskin]] fused with the underlying [[glans penis]] by a common membrane with which both parts are fused.<ref name="deibart1933">{{REFjournal
|last=Deibart
|init=GA
|title=The separation of the prepuce in the human penis
|journal=Anat Rec
|date=1933
|volume=57
|issue=
|pages=387-99
|url=http://www.cirp.org/library/anatomy/deibert/
|quote=
|pubmedID=
|pubmedCID=
|DOI=https://doi.org/10.1002/ar.1090570409
|accessdate=2025-12-03
}}</ref> The membrane, which is called the <i>balanopreputial lamina</i>, is common to both parts, so retraction of the boy's foreskin is prevented by nature. There is good reason for this, since the [[foreskin]] provides protection to the [[penis]] while in the diaper, which usually contains feces, urine, and ammonia.<ref>{{REFjournal
|last=Brennemann
|init=J
|author-link=
|url=https://ia800607.us.archive.org/view_archive.php?archive=/8/items/crossref-pre-1923-scholarly-works/10.1001%252Farchpedi.1915.04110040066007.zip&file=10.1001%252Farchpedi.1921.01910310043003.pdf
|title=The Ulcerated Meatus in the Circumcised Child
|journal=Am J Dis Child
|date=1921-01
|volume=21
|issue=1
|pages=38-47
|doi=10.1001/archpedi.1921.01910310043003
|format=PDF
|accessdate=2025-12-04
}}</ref> Boys with a protective foreskin do not develop [[meatal stenosis]].


The fusion of the balanopreputial lamina gradually breaks down over a widely variable period of years, so the foreskin can be retracted.
When the fusion is separating, it is normal for an [[intact]] boy to report feeling pain when he urinates. When the separation is complete, he will no longer feel pain during [[urination]].
Thorvaldsen & Meyhoff (2005) reported the mean age of first foreskin retraction to be 10.4 years.<ref name="thorvaldsen2005">{{REFjournal
|last=Thorvaldsen
|init=MA
|last2=Meyhoff
|init2=H
|title=Patologisk eller fysiologisk fimose?
|trans-title=Pathological or physiological phimosis?
|language=Danish
|journal=Ugeskr Læger
|volume=167
|issue=17
|pages=1858-1862
|url=https://www.cirp.org/library/normal/thorvaldsen1/
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|date=2005
|accessdate=2025-12-03
}}</ref>
Retraction of the foreskin may become possible as early as age five, but may not occur until after [[puberty]]. Almost every boy can retract by age sixteen.<ref name="Øster1968">{{OesterJ 1968}}</ref>
==Adhesion==
Adhesions of the residual [[skin]] to the [[glans penis]] usually occur after the [[circumcision]] of an infant boy. They are an iatrogenic, pathological condition. When a young boy is to lose his [[foreskin]] to [[amputation]] by the surgical operation euphemistically known as "circumcision", the first step is to break the normal, healthy fusion described above. The surgeon does this in an incredibly brutal manner that causes extreme [[pain]] and [[trauma]] by passing a blunt probe under the foreskin to break the normal fusion with the [[glans penis]]. This preliminary step leaves the [[glans penis]] in a raw condition. After the [[foreskin]] is cut away, the residual shaft skin of the [[penis]] is also left with raw ends.
The surgical wound is not commonly closed with sutures after [[circumcision]] of young boys, so the residual shaft skin is left to fall where it may. If the raw end of the shaft [[skin]] is in contact with the raw [[glans penis]], the two are likely to heal together, which creates a pathological adhesion.<ref>{{REFjournal
|last=Gracely-Kilgore
|first=
|init=KA
|author-link=
|etal=no
|title=Penile Adhesion: The Hidden Complication of Circumcision
|trans-title=
|language=
|journal= Nurse Pract
|location=
|date=1984-05
|volume=9
|issue=5
|pages=22-4
|url=
|archived=
|quote=
|pubmedID=6728346
|pubmedCID=
|DOI=
|doi=
|accessdate=2025-12-04
}}</ref>
Adhesion may also result after premature forcible foreskin retraction (PFFR).
Adhesions take many possible forms. The [[skin bridge]] is a common one.
==The difference==
The <b>fusion</b> with which one is born has a synechial membrane between the [[glans penis]] and the [[foreskin]]. The synechial membrane breaks down with increasing maturity and releases the foreskin, so that it can be retracted and have [[gliding action]].  Fusions are normal and healthy.
The <b>adhesion</b> forms when two raw tissues heal together.  There is no synechial membrane to dissolve and release the connection. The adhesion is pathological and requirs a surgeon to separate the adhesed tissue.
{{SEEALSO}}
* [[Forced foreskin retraction]]
* [[Synechia]]
{{REF}}
{{REF}}
[[Category:Circumcision]]
[[Category:Circumcision term]]
[[Category:Education]]
[[Category:Genital cutting]]
[[Category:Genital surgery]]
[[Category:Male circumcision]]
[[Category:Parental information]]
[[Category:Penile surgery]]
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