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Anatomic penile abnormalities

Last reviewed: 30 Oct 2023
Last updated: 05 Jul 2019



History and exam

Key diagnostic factors

  • newborn and toddler age
  • abnormal location of urethra
  • incomplete prepuce
  • penile curvature and/or torsion
  • recent genital exam or procedure
  • history of short or small penis
  • penile pain and swelling
  • foreskin adherent to glans
  • penile adhesions and smegma
  • penile cicatrix
  • penile glans edema
  • prominent prepubic fat pad
  • presence of hernia or hydrocele
More key diagnostic factors

Other diagnostic factors

  • forced retraction of foreskin
  • dyspareunia
  • recent penile trauma
  • history of balanitis or balanoposthitis
  • urinary obstruction or retention
  • necrosis of penile skin
  • discoloration of glans
  • penile length discrepancy
  • history of UTI
  • history of pelvic or genitourinary surgery
  • erectile dysfunction
Other diagnostic factors

Risk factors

  • uncircumcised penis (paraphimosis)
  • indwelling urinary catheter (paraphimosis)
  • parental unawareness (phimosis)
  • balanitis xerotica obliterans (phimosis)
  • penile trauma (phimosis)
  • recurrent balanitis and balanoposthitis (phimosis)
  • low birth weight (hypospadias)
  • preterm delivery (hypospadias)
  • maternal gestational diabetes, obesity, or hypertension (hypospadias)
  • family history (hypospadias, congenital penile curvature and/or torsion)
  • obesity (buried penis)
  • circumcision (trapped penis)
  • penile and lower abdominal scarring (buried penis)
  • hernia or hydrocele (buried penis)
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Treatment algorithm


phimosis <12 years old, congenital or physiologic

phimosis ≥12 years old



congenital penile curvature and/or torsion

concealed penis <3 years old

concealed penis ≥3 years old




Nicol Corbin Bush, MD, MSCS
Nicol Corbin Bush

Co-Director, PARC Urology

Vice-President, Operation Happenis




NCB declares that she has no competing interests.


Dr Nicol Corbin Bush would like to gratefully acknowledge Dr Nicholas Cost, Dr Linda Baker, and Dr Michael Holzer, previous contributors to this topic. NC, LB, and MH declare that they have no competing interests.

Peer reviewers

David Bloom, MD


Department of Urology

The Jack Lapides Professor of Urology

University of Michigan Medical School

Ann Arbor



DB declares that he has no competing interests.

Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)

Lecturer in Uro-oncology and Consultant Urological Surgeon

Department of Urology

Addenbrooke's Hospital




VG declares that he has no competing interests.

Laurence Baskin, MD


Pediatric Urology

and Professor

Urology and Pediatrics

UCSF Children's Hospital

San Francisco



LB declares that he has no competing interests.

  • Anatomic penile abnormalities images
  • Differentials

    • Balanoposthitis
    • Encircling foreign body
    • Trapped penis
    More Differentials
  • Guidelines

    • Guidelines on paediatric urology
    • Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants
    More Guidelines
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