A boy’s genitals have always been one of the main concerns of his parents, after all, they will be relied upon to carry on the family tradition. It is common for parents to bring their children to the clinic, thinking that their children’s penises are too small. In fact, most of these children are normal, some just look small, but the real penis is not small, but the penis is buried under the skin, resulting in an abnormal appearance. This is called a hidden penis, or sometimes called a buried penis. However, there are a few children who really have dysplasia of the penis itself, which needs to be distinguished from occult penis in clinical practice. One of the causes of occult penis is the abnormality of the foreskin. The foreskin can be divided into two parts: the outer plate and the inner plate. The outer plate is the skin that is normally visible and wrapped around the penis, and its appearance is no different from that of other parts of the skin. The inner plate is located on the inside of the foreskin, which is the skin close to the glans. Children often can’t see the inner plate of the foreskin because the ring is tight and can’t be opened; if it can be opened, you can see that the inner plate is more delicate skin. In occult penis, the outer plate of the foreskin is usually too short, and the opening (circumcision ring) is small, causing the entire penis to be buried under the skin of the perineum. The second reason is the lack of normal fixation between the foreskin and the penis. The foreskin cannot fit close to the penis, so that the penis is buried under the tent-like skin, and from the appearance, the penis appears small and cannot stand out as obviously as the penis of an average boy. This phenomenon is not absolutely related to obesity, but obese people can make the situation worse. The third reason is the abnormal development of the penile meatus membrane. When the sarcolemma is poorly developed, the constricted sarcolemma wraps around the corpus cavernosum of the penis, causing the penis to retract in the body and cannot be extended outward, making the penis hidden but not visible. The clinical manifestations of the occult penis The penis of children with occult penis problem looks small in appearance, sometimes as if it has disappeared. If the skin of the penis is squeezed towards the root of the penis, the penis body will be revealed, but when the hand is released, the penis body will retract. In addition to the abnormal appearance of occult penis, the urine will be like a shower and cannot be aimed. Sometimes, because the opening of the foreskin is too narrow, when you urinate, it is like blowing up a balloon, and the foreskin inflates first before urine is discharged, which is called the “balloon phenomenon. Children with occult penis problems cannot easily keep the foreskin clean, which may cause inflammation of the foreskin or glans. When inflamed, the foreskin becomes red, swollen, itchy, painful, and discharges, and in severe cases, pus may flow, making urination difficult and causing urinary tract infections. What are the diseases that can easily be confused with occult penis? In some children, the penis itself is indeed stunted. In this case, it is necessary to check in detail whether the endocrine function of the penis is normal, including whether there are any abnormalities in testicular size and testicular position. Sometimes even a chromosomal examination is required to determine the sex, because some congenital abnormalities can affect the size of the external genitalia, making it easy to make a gender determination, such as mistaking a girl for a boy, or a boy for a girl. After a proper diagnosis, medication can be used to stimulate penile development, if needed, with minimal side effects. In addition, children with hypospadias are also prone to have similar manifestations of anaplasia and require specialized surgical treatment. The diagnosis of occult penis is generally considered to meet the following five conditions: (1) the penis is short in appearance; (2) the concealed penis is a normally developed penis body under the skin; (3) the normal penis body is revealed when the skin of the stem root is pushed backward by hand, and the penis body retracts rapidly after release; (4) other concomitant penile deformities, such as hypospadias or epispadias, idiopathic micropenis, etc. are excluded; (5) the penis body is partially buried in the prepubic bone in obese infants and children. (5) Except for the case of obese infants whose penis body is partially buried in the prepubic bone. 4. How to treat occult penis Does occult penis require surgery? This depends on the severity of the clinical symptoms of the child. In milder cases, the condition may improve on its own when the child grows older and surgery is not necessary. The appropriate age for surgery is also related to the severity of the symptoms. For more severe cases, it is better to have surgery as early as possible, usually around the age of two. If the surgery is performed after puberty, sometimes there is not enough skin and it is necessary to transplant skin from other parts of the body, which is much more troublesome and the results of the surgery will be poorer. Since the abnormality can be clearly seen in the appearance of the occult penis, it is easy for children to have psychological problems and cause a serious sense of inferiority, so once you decide to have the surgery, it is also advisable to have it earlier. There are many surgical methods, but most of them are to reveal the head of the penis, remove the fibrous cords of the flesh layer, and use the ample inner foreskin plate to make up for the lack of the outer foreskin plate. The most important thing about this type of plastic surgery is that it is safe and easy, and that every effort is made not to have complications. One thing that should always be noted is that these children should never be simply circumcised! In short, once parents suspect that their child’s “penis” is too small, it is best to go to the hospital to see a doctor. If you need early treatment, you will usually have better results.