Sexual health in males is more complex than we think. There are many conditions to consider besides erectile dysfunction.
Some of them are hidden or taken for granted, as it happens with buried penis syndrome.
In such cases, a concealed penis causes insecurity and sexual hesitancy in men. But there are solutions to that problem, including buried penis surgery.
Most patients wouldn’t show an inconspicuous penis to a doctor, and that’s why the condition is often underdiagnosed.
Thus, in this article, we give you the essential information you need to get acquainted with the problem. Hopefully, it will help patients detect this problem and learn about suitable solutions.
What is a buried penis?
Buried penis syndrome is a condition where fat or skin surrounds and hides the penis. These patients with a hidden penis may have a normal penile shaft. However, it is not visible and is buried, surrounded by prepubic tissue. The excess foreskin is visible on the outside instead of the penile shaft.
Penile skin in adult buried penis can be normal. However, it looks excessive because the penis is retracted into deeper tissues. This is associated with obesity, diabetes, and other health conditions in most cases. Still, some patients with the buried penis have relatively normal health, which can be a complication of other diseases.
Surgical management is probably the best option to treat a buried penis. However, patients are often diagnosed very late, in a period of their lives when they are no longer interested in penis length and sexual health.
Learning more about this condition is fundamental, mainly because it is associated with obesity and other diseases (1).
What causes a buried penis?
Adult acquired buried penis has various possible causes. They include:
- Morbid obesity: This is perhaps the most important cause of this condition. An increase of abdominal and pubic fat encompasses and hides the penis. In such cases, a retraction of the excess fat can be enough to release the hidden penis (1).
- Hidradenitis suppurativa: This disease features chronic inflammation affecting the skin. Patients develop abscesses and deformities in their soft tissues. It sometimes manifests as lymphedema with an increase in the size of body parts. This may lead to massive edema in the scrotum and penile tissues, burying the penis inside (2).
- Lichen sclerosus: This is a progressive chronic inflammation that leads to plaque formation in the penis and foreskin. These plaques can make it difficult to retract the foreskin. In some cases, it would hide the penis in the pelvic structures. The condition has been linked with penis cancer and should be evaluated and treated promptly (3).
- Surgical complication: In some cases, a buried penis can be a complication of surgery. For example, after circumcision, scrotal enlargement surgery, and other aesthetic procedures. In such cases, scar tissue develops and creates traction in the penile tissue (1).
- Penoscrotal lymphedema: This is edema in the scrotum and penile area. It is caused by insufficient lymphatic drainage. It happens in cases of elephantiasis and after penile cancer surgery. Patients with prostate cancer may also have this problem if they undergo surgery and the pelvic lymph nodes are taken out (1).
As noted, a buried penis does not have only one cause. Some patients have excess tissue. Others should resolve inflammation problems. Others have a lymphatic drainage issue. The underlying disease can also take the suspensory ligament of the penis. A different approach should be taken to treat the condition in each case.
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Prevalence
The prevalence of adult-acquired buried penis is difficult to ascertain. Some patients would not talk to their doctor about their condition, especially if obesity is involved.
Sometimes, the diagnosis of the problem is incidental and in the late stages of the patient’s life. These patients would only talk about it when the problem renders sexual intercourse difficult or impossible (1).
As such, there are not many prevalence studies of this ailment. One of the first to be published was done between 2008 and 2012. A Japanese study identified a 3.7% incidence of a buried penis in newborns (4). No statistic studies in adults have been performed. However, the incidence should be higher since obesity is one of the leading causes.
Diagnosis
Adult acquired buried penis is often diagnosed through inspection. However, it should be differentiated from other conditions with a similar appearance.
It should be highlighted that the penile shaft in the buried penis is normal. Thus, one of the first differential diagnoses is micropenis. The size of a micropenis is lower than 2.5 standard deviations from the mean size according to the age group.
Besides micropenis, doctors should also consider a differential diagnosis with congenital adrenal hyperplasia, obesity, hypospadias, and some chromosomal abnormalities.
Symptoms associated with the diagnosis include difficulty with vaginal penetration, painful erection, and sexual embarrassment. Some patients will also experience voiding difficulties when standing. In some cases, only the penile skin or foreskin is clearly visible with no trace of the external penile shaft (5).
Complications
Patients with adult-acquired buried penis have a higher risk of additional health conditions. They are not only physical health problems but also a psychological burden that should be considered in these patients.
Early hypotheses mentioned that these patients would probably have a higher risk of urinary tract infections and skin infections. However, they are not often described as complications of a buried penis.
Instead, the most important include (6):
- Penile cancer: Buried penis does not cause penile cancer, but it can result from chronic inflammation. It is the underlying disease that increases penile cancer prevalence. 35% of these patients have premalignant lesions, and 7% develop invasive penile cancer.
- Urethral stricture: It is a reduction of the caliber in the urethral tube. Thus, it leads to urinary problems, increases the risk of urinary infection, and more. It is more common in patients with lichen sclerosis. Urethral stricture happens because chronic inflammation changes the disposition of the tissue, making it harder and losing flexibility.
- Erectile dysfunction: The buried penis syndrome is not by itself a cause of erectile dysfunction. However, according to studies, up to 91% of patients have this problem. Intercourse satisfaction, orgasmic function, and other sexual health parameters are altered in most cases. This may lead to issues with the partner and unsatisfactory relationships.
- Depression: This syndrome has a psychological burden, characterized mainly by depression. According to studies, up to 64% of these patients may develop depression. However, published data usually consists of a few patients and needs further confirmation.
Treatment for buried penis
The management of adult acquired buried penis consists of a surgical defect correction. In some cases, surgery features the removal of excess fat or fixing the penile skin. Sometimes, the foreskin and inner prepuce can be used to fix the tissues in place. The urologist should evaluate the cause and develop proper surgical management in each case.
Buried penis repair is easier in young boys and more successful in toddlers. Thus, early diagnosis and management are fundamental, and parents are encouraged to report any suspicion of a buried penis to their pediatrist (5).
Conclusion
Adult acquired buried penis consists of a normal-sized penis hidden and enclosed by excess body fat or skin. Suspensory ligaments can be involved, and the syndrome can result from inflammatory diseases or a complication after circumcision. However, obesity stands as one of the reasons behind hidden penis problems.
It is essential to diagnose and treat this problem promptly, especially in children, before it starts causing problems. Surgical management is the only available treatment since reconstruction should be done in the penile skin and other tissues. Surgery is planned according to the causes and alterations found in each particular patient.
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