Fusions and adhesions
Fusions and adhesions 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
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.[1] The membrane, which is called the balanopreputial lamina, 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.[2] 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. Thorvaldsen & Meyhoff (2005) reported the mean age of first foreskin retraction to be 10.4 years.[3]
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.[4]
Adhesion
Adhesions of the residual skin to the glans penis usually occur after the circumcision of an infant boy. They are a 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 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.[5]
Adhesions take many possible forms. The skin bridge is a common one.
Unlike fusions, adhesions do not spontaneously dissolve. The services of a pediatric urologist are needed to release the adhesion.
References
- ↑
Deibart GA. The separation of the prepuce in the human penis. Anat Rec. 1933; 57: 387-99. DOI. Retrieved 3 December 2025.
- ↑ Brennemann J. The Ulcerated Meatus in the Circumcised Child
. Am J Dis Child. 1921; 21: 38-47. Retrieved 4 December 2025.
- ↑ Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? [Pathological or physiological phimosis?] (Danish). Ugeskr Læger. 2005; 167(17): 1858-1862. Retrieved 3 December 2025.
- ↑ Øster J. Further Fate of the Foreskin: Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys . Arch Dis Child. 1968; 43(228): 200-3. PMID. PMC. DOI. Retrieved 18 June 2024.
- ↑ Gracely-Kilgore KA. Penile Adhesion: The Hidden Complication of Circumcision. Nurse Pract. May 1984; 9(5): 22-4. PMID. Retrieved 4 December 2025.
