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Ask Dr. Sears: A Problem Circumcision?

Q. My one-year-old son's penis is inverted except when he urinates. His pediatrician says this is normal and due to slight scarring from his circumcision. I'm pregnant with another boy and I am concerned. Are there different circumcision techniques that would be better on my next son? How can I be sure this doesn't happen again?

A. I hear this concern frequently during well-baby checkups. Mothers will often ask, "Is his penis okay? It seems so small!" I assure you that what you describe is nothing to worry about. Many little boys accumulate a lot of fat, called the pubic fat pad, around the base of the penis. A normal penis is there; it's just partially buried beneath the mounds of fat. I often see this with chubby babies. This condition is not caused by circumcision, but the extra fat can push the foreskin far enough forward to make it appear like it is uncircumcised. It would be easy to misinterpret as a problem resulting from the circumcision.

Don't worry—time is on your baby's side. As he grows, so will his penis. Toward the end of the first year and into toddlerhood, infants go through a normal leaning-out stage. They lose a bit of their excess baby fat, including the pubic fat pad. When that happens, your son's penis will protrude more and the foreskin will retract naturally. The penis will look more and more like a normally circumcised one. Also around this age, your baby will start getting normal, frequent erections. Every time your infant gets an erection, the foreskin will retract somewhat more from the head of the penis. With the normal resolution of the pubic fat pad and frequent erections, this curious quirk will self-correct in time.

Since the problem you see now has nothing to do with the circumcision, you don't need to ask your doctor to do anything different with your next baby's circumcision. However, you might want to take the opportunity to ask your doctor some important questions about circumcision. Some doctors used to perform a partial circumcision—that is, removing only part of the foreskin. I discourage this practice because the foreskin tends to grow back. It can then form a lot of scar tissue around the head of the penis and become a nuisance.

If you are worried about this, mention this concern to your doctor. Tell the doctor that you want to be sure your baby has the usual type of circumcision and not a partial one. It's important that enough foreskin be removed so it doesn't grow back. In a typical circumcision, most doctors will remove about one-third of the foreskin to a depth just below the head of the penis.

And one final note on the topic of circumcision: While you're discussing the topic with your doctor, be sure your baby's doctor uses a local anesthetic. This is now the standard, and recommended for all infant circumcisions. If you choose to circumcise your child, there is no good reason why the procedure should cause pain.

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