What Is Buried Penis and How to Treat It

Buried penis (sometimes called concealed penis or hidden penis) is when a penis of typical size is partially or fully hidden by the scrotum or excess tissue (fat or skin) in the pubic area. It can be congenital (the person is born with it), or it can be acquired later, most commonly due to obesity.

The prevalence of buried penis is not known and is believed to be under-reported to healthcare providers. Researchers expect cases of buried penis to increase as the rates of obesity rise.

This article will discuss the types, symptoms, and causes of buried penis, how it is diagnosed and treated, and the prognosis for people who have received treatment for buried penis.

Types of Buried Penis

Buried penis can be categorized into two types:

• Congenital buried penis: Present at birth.
• Adult acquired buried penis (AABP): Develops later in life.

Symptoms of Buried Penis

With buried penis:

• The penis is typically sized but is hidden within skin or fat from the scrotum, abdomen, pelvis, or thighs
• The penis may be completely covered, or the tip of the penis may still be visible
• In some people, a cicatrix (tight band of scar tissue) can form around the penis

Other symptoms associated with buried penis include:

• Difficulty with erections
• Pain with erection or ejaculation
• Problems with urinating, such as dribbling urine or being unable to urinate standing up
• Urinary tract infections
  
• Inability to expose the penis or pain when trying to expose the penis
• Problems with hygiene (urine can become trapped beneath the excess tissue around the penis)
• Inflammation
• Bacterial or fungal infection
• Difficulty or pain with penetrative sex (or the inability to have penetrative sex)
  
• Problems with mental health, such as depression, feelings of self-doubt, or low self-esteem

Causes of Buried Penis

The causes of buried penis depend on whether it is congenital or acquired.

Causes of congenital buried penis include:

• Webbed penis: The penile shaft is tethered to the scrotal midline by a fold or web of skin or is buried in the scrotum.
• Dysgenic dartos: A lack of support from the dartos fascia (connective tissue) to the penis. The connective tissue lacks a good attachment to the suspensory ligament.
  

Causes of acquired buried penis include:

• Having obesity: Most common cause of acquired buried penis. Excess fat around the abdomen, pelvis, and/or genitals can cover the penis
• Genital lymphedema: Swelling of the scrotum from a collection of lymph fluid
• Lichen sclerosus: Inflammation of the genital/anal region, leading to scar tissue, and causing pain and irritation of the tip of the penis or foreskin. May also cause pale, white patches on the skin
  
• Hidradenitis suppurativa: Tissue swelling around the penis from inflamed sweat glands in the groin
  
• Previous surgeries: Scar tissue from previous surgeries (such as penis enlargement surgery) can conceal the penis
• Trauma: Injury to the genital area could lead to swelling and scarring
  
• Phimosis: Scarring of the genital tissue caused by inflammation and infection
• Complications from circumcision: Changes to the external contours of the penis from too much or too little foreskin removed during circumcision
  

Diagnosis of Buried Penis

A healthcare provider can typically diagnose a congenital buried penis through a visual and physical examination without further tests required.

Acquired buried penis can often also be diagnosed through a physical examination by a healthcare provider or, if needed, a urologist.

During the examination, the healthcare provider will get a comprehensive medical history, including how long the penis has been buried and if there are other accompanying symptoms. They will also want to know what the goals for treatment are (restoring sexual function, hygiene, urinating, standing up, etc.).

Other possible penile conditions, such as micropenis (small penis), will also be ruled out.

In some cases, tests such as a cystoscopy (a thin camera inserted into the urethra) or a retrograde urethrogram (an X-ray of the urethra using contrast dye) may be performed.

Treatment of Buried Penis

Children with buried penis often outgrow the condition without intervention. Treatment such as surgery may be necessary if the buried penis is causing problems such as lasting difficulties with urination.

Treatment for an acquired buried penis depends on the cause of the symptoms.

Less Invasive Treatment Options

Fat Loss

If excess fat tissue contributes to the buried penis, a healthcare provider may recommend a fat loss program as a treatment on its own or as a predecessor to further treatments such as surgery. Your healthcare provider may suggest:

• Working with a registered dietitian to make a fat-loss plan
• Exploring bariatric surgery ("weight loss surgery") as an option for fat loss
  

Topical Steroid Cream

Steroid cream applied to the skin can help if there is a tight band of skin around the penis, causing buried penis. This treatment involves exposing the penis by pulling back the nearby tissue and applying the cream multiple times daily. It may take weeks to months for this treatment to work.

Penile Skin Incisions

This treatment, also known as a dorsal slit or revision circumcision, involves one or more cuts made through the scar tissue of the penis. The arrangement of the skin edges allows the scar tissue to open up and expose the penis. Pulling back on the nearby tissue to expose the penis is repeated daily.

Surgery

Surgery may be needed to expose the head of the penis. Several options are available, depending on the cause of the buried penis, the condition of the skin covering the penis, and the shape of your body.

Surgical procedures for buried penis include:

• Ligament manipulation: The ligaments that connect the penis to the body are detached, and the structure is surgically enforced by attaching sutures internally to the base of the penis
• Panniculectomy: Removal of a pannus (large flap of skin which hangs over the thighs and/or genitals)
• Escutcheonectomy: Removal of the escutcheon/mons pubis (the fat pad and tissue just above the penis and below the pannus)
• Abdominoplasty: Excess fat is removed from the abdomen (also called a "tummy tuck")
• Scrotoplasty: Removal of excess skin and scrotal tissue and reshaping of the scrotum
• Suction lipectomy: Surgical catheters that utilize suction are used to remove fat cells
• Skin grafting: Unhealthy tissue, such as scar tissue, is removed, then the exposed penis is covered with skin from other areas (such as the leg or from the tissue that was already removed from the abdomen)
  

Prognosis

People with a buried penis who undergo surgical treatment often see improvement in areas such as:

• Sexual considerations, such as erectile function, ejaculation, and overall sexual satisfaction
• Urinary function
• Genital hygiene
• Aesthetics

A buried penis related to obesity can recur if lifestyle steps are not taken to reduce and keep off excess fat in the genital area. Talk to your healthcare provider about strategies for preventing the buried penis from recurring.

Coping

Living with a buried penis and undergoing treatment can present physical and mental challenges. Mental healthcare, such as psychological counseling, can be beneficial for working through the complex emotions associated with this condition.

Summary

Buried penis is a condition in which a typically-sized penis is partially or fully covered by the scrotum or tissue in the pubic area. It can be congenital or acquired.

Buried penis can be caused by structural abnormalities, such as webbed penis or dysgenic dartos. It can also be caused by factors such as obesity, scarring and other tissue in the genital area, inflammation, and trauma.

Congenital buried penis typically improves on its own as the child ages. Acquired buried penis and buried penis causing problems with functioning can be treated with topical creams, penile skin incisions, or surgery.