UPDATED....My long letter to the doctor about penile adhesions...
Here is the reply I received from my son's pediatrician. I am impressed how quickly he got back to me.
Thank you for your letter and I appreciate the concern that you have. The penile adhesions that Evan has are very common in infants who have been circumcised. One recent reference mentioned 71% of infants will have adhesions following this procedure. There is nothing that really can be done to guarantee that they won't happen. If you were to forcefully pull the foreskin back to try to prevent the adhesions we may still be in this situation. Sometimes by pulling the skin back it irritates the tissue and just promotes another adhesion to form. The standard of care today in Pediatrics is to not force the foreskin back. In times past this was the recommendation, but the advice has changed. By pulling the foreskin back you can cause pain, bleeding, increased risk of infection and recurrent adhesions. If you let the natural process take place, 90+% of adhesions will work their way back on their own by 3 years of age. At this point, my advice would still be to wait for this natural process to take place and there is no real need for any other concern at this time.
So what do you think ladies? Should I send it?
I just saw you for Evan's six month appointment and wanted to address something I needed to think about a little more concerning his penile adhesions.
After Evan's circumcision I was told to do no other care than put Vaseline on it for diaper changes so it wouldn't stick. Being a first-time mom, I have never seen a newborn penis before and other than your observation that it was a little "rotated" I assumed it was fine. I understand now that his circumcision is loose and I would rather it be that way than too much skin taken. However, I really wish I had been instructed on the importance of pulling the foreskin back to help prevent penile adhesions. With all the things new mothers have to think about, I didn't hear about this and never even knew to do this from the very beginning. In fact, I thought that pulling foreskin back was only important for cleaning an uncircumcised penis.
I kind of figured it out on my own as time went on that there seemed to be a lot of skin and it was a good idea to pull it back, but it was probably after adhesions had already formed. I feel guilty for not knowing what to do...but, at the same time, how was I to know? Books only cover so much and all my close friends have girls. Now I am told that for "most" babies this will go away on its own as they get older.
However, I do know that it doesn't go away for all babies and can be a problem. Now I am concerned about what I (well, Evan) may have to deal with if these adhesions don't "correct themselves". I guess I have to wait and find out...but considering his penis is already a little "different", it makes me sad to worry about this for him as well. I end up putting so much faith in the ever-so-popular reassurance that "well, most babies"...and I am overwhelmed by that. Always holding onto hope that my baby will fall into what is seen in most babies....and knowing we'll have to deal with the consequences if he doesn't.
So, the purpose of this letter to you is to ask you a favor. Please tell all parents that it is important for them to pull the foreskin back (what is left after circumcision) and to put Vaseline there as well with the purpose to prevent adhesions. I never knew this, so I am sure there are other parents who don't as well. I know it isn't a guarantee that Evan wouldn't have any if I had known to do this, but at least I would have felt informed on what to look for and proper care. I just don't want other parents to not be aware of this and find out down the road like I did - after adhesions have formed. I know that these things "are quite common"...but maybe they wouldn't be so common if doctors knew to tell parents what could happen and the steps to take to make it less likely. It's too late for Evan - his adhesions will either correct themselves or he will have to go through a possibly painful procedure in the future.
The reason I felt it important to write this is because I think sometimes doctors forget that new parents really don't know about some of these things - and we trust in you to keep us educated.