Good News! A Better Way to Treat the Dreaded Penis-In-Zipper

Pity the boy who has one of the more tragic types of wardrobe malfunction. Usually  it goes down, so to speak, like this:  a prepubertal boy, perhaps going commando (sans underwear) or dressing hurriedly, traps some part of his male anatomy in the working teeth of his zipper while closing his fly. The result? Paralyzing pain, followed by earthshattering yells. What’s worse,  efforts to free the child cause heightened spirals of discomfort and anxiety. Oops, there it is: penile zipper entrapment.

For all male readers, this may be a good time to uncross your legs while we figure out what this is, and share some improved ways to address the problem.

Research suggests (and reassures us) that zipper-related injuries to the genitals are rare, occurring mostly in boys aged 2-12 years, and comprised only about 1 in every  4000 new patients in one pediatric ER surveyed.  As one might imagine, the vast majority of these events are accidental, occur during dressing (or, say peeing hurriedly outside), with boys catching themselves as they zip their fly up (unzipping injuries? not so much).   Usually, the zipper catch scratches are superficial, involving abrasions or mild lacerations of the skin of the penis. More rarely, zipper mechanisms can snag any part of the male genitalia, and can involve substantial amounts of tissue, resulting in more severe injury. Always, the pain is intense, and the bleeding can be impressive,  heightening a child’s dismay. What to do during these miserable times?

First: Aid!

Upon finding one’s child in a bad way with a zipper,  have them lie down in a position to relieve traction of their clothing upon their trapped skin. Go easy! To the extent possible,  exert a calming voice and assess the child while you do so. Lighthearted humor as a distracting device has little place here, as you may see. These kids are upset, and miserable. Look about: what parts got stuck (glans? foreskin? scrotum?)? What didn’t? Is there bleeding, or any other injury? Your observations will matter in case you end up speaking to a clinician or dispatcher over the phone.  Take notes, but not pictures!

Once the child is situated as comfortably as possible, apply a clean towel with gentle but firm pressure to the area to stop any oozing blood. If a wound extends to the scrotum place a folded towel in the former diaper area both to staunch bleeding and offer some comfort.  Keep extra towels handy to drape over private parts for boys who may feel extremely self conscious, or who may need to be moved about. Exude calm and confidence, even if you feel you might toss your cookies.

A lot of the time, shocked boys will extricate themselves with a surprised and rapid unzip. For unlucky boys whose efforts are unsuccessful at freeing trapped skin by unzipping, an urgent clinic or ER visit may be required. Parents may consider calling their child’s primary care practice for guidance and further management pointers.  Because of the sheer discomfort and awkwardness of these events, the children still ‘in-zipper’ will likely be unable to walk. Plan on carrying them, and get assistance if needed.

Treatment, evolved.

Per classical teaching, a child with a more severe case of penile zipper entrapment presenting to the emergency room would face rather intimidating medical approaches.  On paper, it sounds simple: cut or disassemble the bars of the zipper, unlock the teeth of the mechanism and liberate trapped tissue, right? In practice, this is harder than it sounds (zippers are built tough!), and providers may require the use of heavy duty scissors, wire cutters, or screwdrivers for the job. Needless to say, littluns already having a bad day with their nether bits all zippered tend to respond unhappily (and, um, loudly) when grownups with large tools and cutting implements approach their groins.  What’s more, syringes of lidocaine used for a penile nerve block may a) not be that effective anyway; while b) cause it’s own emotional trauma (“You’re gonna put that where?”) You get the idea.

Happily, a recent presentation by Dr. Steven M. Selbst of Jefferson Medical College, offers a much less aggressive, cheap, effective, and low tech approach to these enzippered boys.  Better still, it may be done safely at home, or in the office.  His solution? Mineral oil. Lots and lots of mineral oil.

Selbst’s approach recommends:  Apply mineral oil liberally to the genital area and zipper mechanism of the trapped kiddo, making sure everything is good and soggy and doused. Then, let the boy rest quietly for 20-30 minutes while the oil sets in and softens the whole business. In many cases, the mineral oil helps trapped flesh extricate on it’s own. And, in more recalcitrant cases, gentle pressure with a cotton ball may coax out tissue still trapped in the zipper. Then, Voila!

For parents who are unsure, or reluctant to do the job themselves, I might recommend they apply the mineral oil to the child’s zipper and trapped flesh before leaving to be seen by a healthcare provider. And, to be sure, you may want to ask them in advance. Ideally, the “situation down there” may resolve itself by the time everyone arrives to the clinic or emergency room, or it saves waiting for the mineral oil to do it’s magic once there. Like the best of good ideas, mineral oil may help and it won’t hurt.

Once kids are liberated from the confines of their zippers, the wounds to the genitals should be checked out. No more bleeding? All parts present and accounted for? For the rarer, more extensive injury–beyond a shallow tear, and anything that looks like it may cause some deformity–may require some specialists’ attention.  If at all unsure, consult a health care provider. Down the road, cosmetics (and function) matter!  Fortunately, the ample blood supply to this part of the body lends itself to rapid healing.  Parents may need to check the area carefully in the first few days to make sure there is no infection.

And while it may not be easy to persuade young boys to wear clean underwear, the concern for penile zipper entrapment makes a great argument for wearing some underwear. And, for zipping slowly.  And for we parents, we finally have some use for those bottles of mineral oil that sit for years in our medicine cabinets.

Photo above by Chris 73 (link: http://commons.wikimedia.org/wiki/File:YKK_Zipper_on_Jeans_close_up.jpg )

Dr Selbt’s presentation summarized here: http://www.pediatricnews.com/newsletter/the-crier-e-newsletter/singleview120227/best-way-to-treat-penis-in-zipper/16332743bf.html

Cartoon by me.

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