Some parents bring their children to the doctor and say that their children have small penises, even so small that they seem to have no penis, only a bunch of foreskin left there, and they don’t know what’s going on. Parents are worried about whether their child will be a “real man” when he becomes an adult. Some parents also think that their children are small and “circumcised” and ask to be circumcised. In fact, this kind of children may be occult penis! What is occult penis? The normal meatus is an elastic structure that helps the skin of the penis to slide freely. If the meatus is not well developed and has poor elasticity, it also limits the expansion of the penis and fixes the penis below the pubic symphysis. We found that occult penis has normal penile body, only the fibrous cords due to the poorly developed sarcoid layer fix and bury the penile body in the subcutaneous tissue, and these patients often have a thick subcutaneous fat layer in front of the pubic bone. A simple way to confirm whether the penis is occult or not is to pull the head of the penis by hand and then release it and observe the retraction of the penis; if the penis retracts quickly, the diagnosis is made. Another method is to squeeze the foreskin of the penis toward the pubic bone with your hand and find that the entire penis is revealed, but once you release the hand, the penis retracts back in. Although occult penis looks like circumcision, they are two completely different diseases. This is because the outer skin of occult penis is not too long, but too short, and its penile body is not small but normal. It occurs for three reasons: first, the penile skin is stunted and too short; second, the foreskin cavity is too small; third, the penile skin does not wrap around the penile corpus cavernosum, resulting in the penile corpus cavernosum being unsupported and retracted inside the body. If the occult penis is not operated, it will be allowed to grow this occult and cannot be extended outward, and the development of the penis body will be restricted. Therefore, occult penis must be given corrective treatment within a certain age (5-7 years old). Second, can it be done without surgery? Some doctors think that occult penis is just a developing penis and will resolve on its own after puberty, so they do not recommend any surgery. Only a few people in the course of our clinical practice have undergone certain changes during puberty, and the fatty layer in front of the pubic bone disappears and is cured without treatment. In most patients the dysplastic meatus is still present and still requires surgical treatment. What’s more, boys start to pay attention to their genitals before puberty, and occult penis can cause them to have low self-esteem and emotional disorder. Third, is circumcision necessary? Circumcision should never be done! If you misdiagnose anaplasmosis as circumcision, it will lead to a shortage of penile skin, and once the spongy body of the penis is deprived of the skin, the development of the penis will be inhibited. Fourth, how to surgically treat? Most choose to perform penile decortication and fixed lengthening, which is corrected by removing the inelastic fleshy membrane to make the penis elongate and fit with the length of the foreskin. After removal of these dysplastic fibrous cords, the penis will be sufficiently loosened and it will be found to be of sufficient length to require all the foreskin to cover it. In some severe cases, removal of only the fibrous cords is not yet sufficient to completely correct the problem, and removal of the thickened fat layer over the pubic bone is also required. This is the only way to achieve a good cosmetic result.