Buried Penis

Buried penis (also called concealed or hidden penis) is a condition in which the penis is partially or fully covered by the skin of the scrotum, abdomen, or thighs. Although a buried penis may be (and often is) normal in size, it is hidden under the skin, so it does not fully protrude (stick out) from the body.

This uncommon condition can be present at birth or develop later in life. It can cause several complications such as difficulty or pain with intercourse, urinary symptoms, hygiene issues, and problems with self-esteem. Fortunately, buried penis can be treated through surgery and may be improved with weight loss.

The primary symptom of buried penis is that only the tip (if any) of the penis is visible. Nevertheless, it is often accompanied by several physical and psychological problems. The following are some of the complications that may come as a result of buried penis:

• The inability to have penetrative sex if the penis is trapped beneath skin
• Pain during intercourse
• Painful erections and/or ejaculation
• Difficulty with urination (e.g., not being able to pee standing up)
• Dribbling urine
• Frequent urinary tract infections (UTIs)
• Poor hygiene
• Skin infections due to hygiene issues
• Unhealthy penile skin due to inflammation and scarring
• Depression
• Anxiety
• Low self-esteem or impaired sexual self-image
• Penile squamous cell carcinoma (penile cancer) that may occur due to chronic inflammation from the trapping of urine

A person with buried penis may experience any or all of these complications, depending on the severity of their condition.

Buried penis can be caused by problems with the ligaments that attach the penis to the body, excess fat around the abdomen, fluid retention in the genital area, or complications after circumcision. It can also be caused by rare skin conditions such as lichen sclerosus or hidradenitis suppurativa. The following is a more detailed explanation of each of the possible causes of buried penis:

• Abnormalities in the penile structure at birth. Some individuals are born with buried penis. This occurs when the ligaments and connective tissues that attach the penis to the body are too weak or lax to properly support the penis.
• Excess fat, particularly around the abdomen and genitals, can cover the penis and make it appear hidden. This is the most common cause of adult-acquired buried penis.
• Genital lymphedema. Lymph fluid may collect around the scrotum, sometimes causing enough swelling to bury the penis.
• Complications after circumcision. Buried penis may develop after circumcision if too much (or not enough) of the foreskin is removed. However, research suggests that buried penis after newborn circumcision is not permanent and generally resolves itself as the infants get older.
• Chronic skin conditions that affect the groin. Lichen sclerosus causes itchy white patches of skin, usually in the genital or anal areas. Hidradenitis suppurativa causes lumps under the skin of the armpits or groin. Both of these conditions can lead to inflammation and changes in the skin that can affect the penis. For example, lichen sclerosus can cause phimosis (a condition in which tight foreskin cannot be pulled back), and a phimotic band may pull the penis back and bury it. On the other hand, hidradenitis suppurativa can lead to lymphedema and subsequent swelling that covers the penis.

Typically, a health care provider can diagnose buried penis through a visual inspection and physical exam. A trained professional can help rule out other possible penile conditions such as micropenis, which is a small penis. Therefore, if you believe you may have buried penis, it is important to have it confirmed by a primary care doctor or urologist.

In infants and very young children, buried penis may go away on its own as the child gets older. Additionally, individuals with mild cases may find that weight loss and/or topical steroid creams that loosen the foreskin help (in cases related to phimosis). Nevertheless, surgery is usually required to treat buried penis. The following surgical options focus on removing fat or reinforcing the penile support structure to treat buried penis:

• Abdominoplasty, also called a “tummy tuck,” is a procedure to remove excess fat from the abdomen.
• A panniculectomy is performed to remove a pannus, which is a large flap of skin that hangs over the thighs and genitals. This excess skin can be the result of significant weight loss.
• Escutcheonectomy involves the removal of the fat pad above the pubic area.
• Scrotoplasty is a surgery that corrects and reshapes the scrotum by removing excess skin in the area. This skin can also be surgically rearranged to cover the shaft of the penis if necessary.
• Suction lipectomy removes fat cells through surgical catheters that utilize suction.
• Skin damage repair, which involves removing any scar tissue or damaged skin around the penis, uses skin grafts to cover the areas of the penis where skin is compromised or lacking. The skin grafts can come from the fat pad that has been removed or from the thigh.
• Ligament manipulation can be done by detaching the ligaments that connect the penis to the body and surgically enforcing the structure by internally attaching sutures to the base of the penis.

No matter which treatment option is used, buried penis patients may also benefit from psychological counseling. Issues related to sexual dysfunction and self-esteem are complex, and a mental health professional can help an individual navigate these challenges.

References:

Buried or Hidden Penis: Treatment, Symptoms, Causes. (2020, December 18). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16291-buried-penis

Cavayero, C.T., Cooper, M.A., & Harlin, S.L. (2015). Adult-Acquired Hidden Penis in Obese Patients: A Critical Survey of the Literature. The Journal of the American Osteopathic Association, 115(3), 150-156. https://jaoa.org/article.aspx?articleid=2211854

Eroğlu, E., Bastian, O.W., Ozkan, H.C., Yorukalp, O.E., & Goksel, A.K. (2009). Buried penis after newborn circumcision. The Journal of urology, 181(4), 1841–1843. DOI: https://doi.org/10.1016/j.juro.2008.12.006

Ho, T.S., & Gelman, J. (2018). Evaluation and management of adult acquired buried penis. Translational andrology and urology, 7(4), 618–627. DOI: https://doi.org/10.21037/tau.2018.05.06

Monn, M.F., Chua, M., Aubé, M., DeLong, J.M., McCammon, K.A., Gilbert, D., Jordan, G.H., & Virasoro, R. (2020). Surgical management and outcomes of adult acquired buried penis with and without lichen sclerosus: a comparative analysis. International Urology and Nephrology, 52(10), 1893-1898. https://link.springer.com/article/10.1007/s11255-020-02486-y

Pestana, I. A., Greenfield, J. M., Walsh, M., Donatucci, C. F., & Erdmann, D. (2009). Management of “buried” penis in adulthood: an overview. Plastic and Reconstructive Surgery, 124(4), 1186-1195. DOI: 10.1097/PRS.0b013e3181b5a37f  

Rybak, J., Larsen, S., Yu, M., & Levine, L.A. (2014). Single Center Outcomes after Reconstructive Surgical Correction of Adult Acquired Buried Penis: Measurements of Erectile Function, Depression, and Quality of Life. The Journal of Sexual Medicine, 11(4), 1086-1091. https://www.jsm.jsexmed.org/article/S1743-6095(15)30731-1/fulltext

Shaeer, O., & Shaeer, K. (2009). Revealing the Buried Penis in Adults. The Journal of Sexual Medicine, 6(3), 876-885. https://www.jsm.jsexmed.org/article/S1743-6095(15)32410-3/fulltext

What is Buried Penis? (n.d.). Urology Austin. Retrieved December 13, 2022, from https://urologyaustin.com/male-urology/buried-penis/