Be wary of the “small” penis of obese children The genitalia of boys, which we call “the root of life”, is traditionally one of the key concerns of parents because of the important task of passing on the genes to future generations. In the clinic, there are often parents who think that their children’s “penis” is too small compared to other children or circumcised to visit the clinic. Usually, most of these children are obese, have normal intelligence, growth and development, and their penis only looks small in appearance, but in reality, it is buried under the skin and has an abnormal appearance due to the accumulation of fat in front of the pubic bone. Medically, we call this disease occult penis. What are the clinical manifestations of occult penis? Children with occult penis problems have a short penis that is hidden under the skin. In severe cases, all that is visible is an empty foreskin and the body of the penis cannot be seen. If the penile skin is squeezed towards the root of the penis, the penis body will be revealed, but once the hand is released, the penis body will retract again. In addition, affected children often have wet urine pants, short urine lines, inability to aim, and in some cases, even inability to stand to urinate. The child 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 discharging, and in severe cases, it can become pus-filled, difficult to urinate, and cause urinary tract infections. If children with occult penis problems are not corrected in time, it will cause penile dysplasia and affect their sex life and fertility in adulthood. As children grow older, they become aware of the differences between them and their peers and may develop a sense of inferiority. What are the causes of occult penis? One of the causes: The lack of normal fixed structures between the penile skin and the penile body, the separation between the penile skin and the penile body, and the empty foreskin, like a tent without a support pole, cannot be propped up. From the appearance, the penis appears small and cannot be as prominent and obvious as the penis of an average boy. This phenomenon is not absolutely related to obesity, but obese people can make the situation worse. Cause No. 2: Abnormal development of the penile meatus membrane to form fibrous strips. The flesh membrane is located between the subcutaneous tissue of the penis and the body of the penis, when the flesh membrane is poorly developed, the fibrous cords wrap around the spongy body of the penis, just like the penis wears a layer of strong armor, resulting in the penis cannot be extended. Children with severe circumcision usually have a narrow foreskin ring that cannot be turned over, or too much foreskin is removed due to circumcision surgery to the point that it cannot wrap the penis body, while post-operative scar formation makes the penis concealed and not visible. In recent years, the incidence of occult penis has increased significantly, and some people believe that it is related to the excessive intake of high-calorie fried food or fast food by children nowadays. What are the diseases that differentiate occult penis from? Some boys have a short penis from the outside and the glans cannot be exposed, so they are often misdiagnosed as having a prepuce, but in fact it is an occult penis. If the length of the penis is normal, but the opening of the foreskin is narrow and the opening of the penis cannot be exposed, it can be diagnosed as prepuce. If the penis has a small appearance and the spongy body of the penis is found to be normally developed during examination, but is deeply hidden in the fatty tissue of the pubic bone. After pushing back the skin around the penis with the hand and pulling the glans, the penis can be revealed, but the penis body quickly retracts into the fatty tissue of the pubic bone after releasing the hand, and the skin covering the penis is very short, then it can be diagnosed as occult penis. The penis is highly curved and covered by a turban-like foreskin and a split scrotum, but the urethra opens in the perineum. In congenital penile agenesis, the penis is not visible on visualization of the vulva and cannot be found under the skin of the scrotum or pubic bone. It is a serious congenital malformation. In some children, the penis itself is indeed underdeveloped. In this case, it is important to examine in detail whether their endocrine function tests are normal, including any abnormalities in testicular size and testicular position. In some cases, congenital anomalies may affect the size of the external genitalia, making it easier to make a gender determination, such as mistaking a girl for a boy or a boy for a girl, and a chromosome test should be done. What should be the treatment for occult penis? The treatment for occult penis is first, weight control, which can improve the symptoms; second, regular visits to the hospital before school age to observe the development of the penis; and third, surgery, which depends on the severity of the child’s condition. The simpler way to determine the degree of occult penis is: if the penis is completely hidden under the skin and only the foreskin can be retrieved on the abdominal wall, it is considered severe. If the penis is mostly hidden under the skin, and the head of the penis is pulled, most of the penis body can be exposed, but it retracts quickly after being released, it is considered moderate. In milder cases, the condition may improve on its own when the child grows older and surgery is not necessary; however, in children with more severe symptoms, the condition usually does not improve with age and requires surgery. 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. The reasons are: one, with the prolongation of the encapsulation, it will lead to poor development of the penile body. Secondly, because of the abnormal appearance of the occult penis, it is easy for children to have psychological problems and cause a serious sense of inferiority. Therefore, once you decide to have the surgery, it is also advocated that it is better to have it earlier, and the surgery should be performed before puberty. 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. We have accumulated a lot of experience with this type of plastic surgery, and the most important thing is to be safe and easy, and to do our best not to have complications. The one thing that should always be noted is that these children should never be simply circumcised! In conclusion, we all need to have a correct understanding of occult penis, pay attention to its difference from circumcision, and if surgery is needed, it is advisable to perform it early in order to obtain a more satisfactory result.