An 8-month-old infant was brought for evaluation because of concerns about the small appearance of his penis (A). The infant was born to a 25-year-old mother after an uncomplicated, full-term pregnancy and normal vaginal delivery. Birth weight and length were 4.2 kg (9.3 lb) and 52 cm (20.5 in), respectively. Circumcision was performed in the neonatal period.
The infant's current weight and length were 10.2 kg (22.6 lb) and 77 cm (30.3 in), respectively. The penis became noticeable when pressure was applied to adjacent skin (B). The stretched penile length was 3.2 cm (1.25 in), which is normal for the patient's age. Both testes were descended. The urethral meatus and scrotum were normal.
An otherwise normal penis that appears small—a concealed penis—can have any of a number of causes. These include excess peripubic fat; a deficiency of penile shaft skin, such as from overzealous circumcision; and poor attachment of the penile skin and dartos fascia to the Buck fascia and corporeal bodies.
A concealed penis must be differentiated from a micropenis—a penis that measures less than 2 standard deviations below the mean for age in stretched length from the pubic symphysis to the tip of the glans penis. A micropenis often results from gonadotropin deficiency. When this condition is associated with hypoglycemia, suspect panhypopituitarism.
A concealed penis is asymptomatic. It often resolves at puberty, as the penis size increases and the peripubic fat shrinks.
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