Webbed Penis: Symptoms, Types, Causes and Treatment

Webbed penis, also known as penoscrotal web, is a congenital or acquired condition where the skin of the scrotum abnormally extends onto the underside (ventral surface) of the penis. This can cause both functional and aesthetic issues, especially in children but also in adults. Understanding the symptoms, classification, causes, and treatment options for webbed penis is essential for parents, patients, and healthcare providers. This comprehensive guide synthesizes the latest research and surgical approaches to provide a clear, evidence-based overview of this condition.

Symptoms of Webbed Penis

Webbed penis presents with a distinctive set of symptoms, primarily visual and physical, which can affect children and adults differently. Early recognition is important for appropriate management and to allay parental concerns.

Appearance	Physical Effects	Psychological Impact	Source(s)
Ventral skin web	Concealed shaft	Body image concerns	2, 4, 6
Blunted penoscrotal angle	Difficult hygiene	Parental anxiety	2, 4
Shaft-scrotum fusion	Interference with urination/erection	Social embarrassment	6

Table 1: Key Symptoms

Visible and Physical Signs

The hallmark symptom of webbed penis is the presence of a web or fusion of skin extending from the scrotum onto the underside of the penis. This usually results in a blunted or absent penoscrotal angle, making the penis appear shorter or partially "buried" within the scrotal tissue 2 4. In infants and young boys, this can cause parental concern, especially during diaper changes or bathing.

Functional Implications

While many cases are mild and purely cosmetic, more severe forms can:

• Conceal part of the penile shaft, making hygiene difficult
• Interfere with urination by distorting the ventral aspect of the penis
• Affect erections in adolescents or adults due to abnormal skin tension 2 6

Psychological and Social Effects

For older children and adults, the appearance of a webbed penis can cause embarrassment, self-consciousness, or psychological distress. Parents may also experience anxiety regarding their child's genital development 6.

Types of Webbed Penis

Understanding the classification of webbed penis is crucial for diagnosis and determining the best treatment approach. Recent research has refined the classification into distinct types based on anatomy and origin.

Category	Subtypes	Defining Feature	Source(s)
Primary	Simple, Compound	Congenital origin	1
Secondary	N/A	Acquired after surgery	1, 7
Grading	Mild (Grade 1), Moderate (Grade 2), Severe (Grade 3)	Extent of webbing	2, 7

Table 2: Classification of Webbed Penis

Primary Webbed Penis

Primary webbed penis is present at birth and subdivided as follows:

• Simple: Webbing is limited to the penoscrotal junction, without involving the distal shaft.
• Compound: Webbing extends further along the shaft, sometimes involving the preputial or ventral penile skin 1.

Secondary Webbed Penis

Secondary webbed penis arises after surgical procedures, most commonly circumcision. In these cases, excessive removal or scarring of ventral skin causes the scrotal skin to adhere to the penile shaft, creating a secondary web 1 7.

Grading Severity

Some studies further grade webbed penis based on how far the web extends up the penile shaft:

• Grade 1 (Mild): Web involves only the base of the penis.
• Grade 2 (Moderate): Web extends up to the mid-shaft.
• Grade 3 (Severe): Web reaches the glans or coronal sulcus 2 7.

Grading helps inform the choice of surgical correction technique.

Causes of Webbed Penis

The origin of webbed penis is multifactorial, involving both congenital and acquired factors. Understanding the underlying cause is essential for tailored management.

Cause Type	Mechanism	Risk Factors	Source(s)
Congenital	Abnormal scrotal dartos insertion	Genetic/developmental	1, 2
Acquired	Surgical complication	Circumcision, trauma	4, 5, 7
Associated	With other anomalies	Buried penis, chordee	3, 5

Table 3: Causes of Webbed Penis

Congenital Causes

Most cases are congenital and result from abnormal development of the scrotal skin or dartos fascia, which extends abnormally up the ventral shaft of the penis 1 2. This may be due to:

• Faulty insertion of the scrotal dartos muscle
• Incomplete separation of scrotal and penile skin during embryogenesis

Acquired Causes

Webbed penis may also develop after surgical interventions, particularly circumcision. If too much ventral shaft skin is removed, or if improper healing occurs, the scrotal skin can adhere to the penile shaft, forming a secondary web 4 5 7.

• Post-circumcision scarring is the most common acquired cause
• Trauma or infection may also contribute

Associated Conditions

Webbed penis can be part of a spectrum of penile anomalies, including:

• Buried penis
• Chordee (downward curvature)
• Hypospadias (abnormal urethral opening) 3 5

In such cases, webbing may co-exist or complicate the presentation.

Treatment of Webbed Penis

Treatment decisions for webbed penis are individualized, depending on severity, symptoms, and patient/parental concerns. Modern surgical techniques and tailored approaches have greatly improved outcomes.

Approach	Indication	Outcome/Benefit	Source(s)
Observation	Mild, asymptomatic cases	No intervention needed	5
Modified Circumcision	Webbing with straight shaft	99% success rate	5
Surgical Correction	Moderate/severe, failed circumcision	Excellent cosmetic/function	2, 4, 6, 7
Technique Selection	Based on grade/type	Tailored results	1, 7

Table 4: Treatment Options

Non-Surgical and Conservative Management

• Observation: Mild, asymptomatic cases may not require intervention, especially if the web does not extend beyond the penoscrotal junction and causes no functional or cosmetic concern 5.
• Physical Therapy: After certain circumcision techniques, families may be instructed in gentle skin “push down” exercises to help prevent recurrence or worsen webbing 5.

Modified Circumcision Techniques

For infants and young boys with a webbed penis and a straight shaft, modified circumcision using an oblique incision (retaining more ventral skin) combined with post-operative skin therapy can be highly effective. In a large study, this approach achieved a 99% success rate, comparable to circumcision outcomes in boys without penile anomalies 5.

• Avoids unnecessary surgical reconstruction in most cases
• Quick recovery and high parental satisfaction

Surgical Correction

Surgery is indicated for:

• Moderate to severe webbing
• Failed conservative or circumcision-based management
• Functional problems or psychological distress

Pediatric Surgical Techniques

• Penile Degloving and Dartos Excision: Complete degloving, removal of abnormal scrotal dartos, and penoscrotal fixation sutures restore a normal penoscrotal angle and cosmetic appearance. This method is versatile and effective for most congenital cases, with a high satisfaction rate and minimal complications 2 4.
• Tailored Techniques by Grade:
  • Heineke-Mikulicz (HM) Scrotoplasty: For mild (Grade 1) webbing.
  • Multiple Z-Plasty: For more extensive (Grade 2 or 3) cases, allowing greater tissue lengthening and skin rearrangement 7.

Adult Surgical Correction

Adults with persistent or bothersome webbing may benefit from:

• Novel Plastic Surgical Techniques: Procedures designed to expose the glans, correct curvature, and create a normal penoscrotal junction. These produce excellent cosmetic and functional results with minimal complications 6 8.
• Aesthetic Scrotoplasty/Ventral Phalloplasty: For cases with excessive scrotal skin or persistent penoscrotal webbing, a combination of scrotal skin resection and Z-plasty at the penoscrotal junction can be considered 8.

Outcomes and Complications

• Most surgical techniques yield high rates of cosmetic and functional success 2 4 6 7.
• Minor complications (e.g., self-limited edema, wound infection, hematoma) are rare and typically resolve without intervention.
• Recurrence is uncommon, especially when the technique is suited to the grade/type of webbing 4 7.

Conclusion

Webbed penis is a relatively common but under-recognized condition that can impact both physical function and psychological well-being. Advances in classification and surgical management have led to excellent outcomes for affected individuals. In summary:

• Symptoms include concealment of the penile shaft, blunted penoscrotal angle, potential functional effects, and psychological impact.
• Types are classified as primary (simple/compound) or secondary, with additional grading by severity.
• Causes are most often congenital but may be acquired post-surgery; associated anomalies may coexist.
• Treatment ranges from observation to modified circumcision and tailored surgical correction, with high success rates and parent/patient satisfaction.

Key Takeaways:

• Early recognition and grading help guide management.
• Mild cases may resolve with conservative care or modified circumcision.
• Surgery is effective for moderate/severe cases, with minimal risks.
• Modern techniques are customizable to individual anatomy and needs.
• Parental and patient reassurance is critical for psychological well-being.

If you or your child have concerns about webbed penis, consult a pediatric urologist or surgeon experienced in genital anomalies for personalized advice and treatment.