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Illustration of a penis with hypospadias showing the urethra exiting before the head of the penis.

Hypospadias explained

Hypospadias is one of the most common birth anomalies there is. It occurs in 1 out of every 125 to 250 boys, although mild forms of hypospadias may be even more common than this.

Hypospadias is a condition where the urethra doesn’t go to the end of the penis. The urethra is the tube inside the penis that urine and semen pass through. In mild cases of hypospadias, the urethra comes out near the end of the penis, but not quite. In more severe cases, it can come out anywhere from below the head of the penis to the area between the scrotum and anus which is called the anogential region.

It makes sense that hypospadias occurs on the bottom side of the penis where nature left what appears to be a long seam. The seam occurs when the penis is forming in the fetus. It’s just below where the urethra goes. As part of fetal development, nature fuses or “zips up” the shaft and head of penis to make it look more like a sausage. Where there is hypospadias, the urethra got caught in the seam.

The possible reasons for a boy being born with hypospadias range from genetics and environmental pollutants called endocrine disrupters to maternal, age, diet and drugs or hormones she may have taken before or during pregnancy. (One study cites diet and obesity of the mother during pregnancy could be possible risk factors, with a vegetarian diet or a diet lacking in meat and fish showing a positive association with hypospadias risk. Drugs given during fertility treatments and cocaine are also associated with hypospadias.)

The vast majority of hypospadias cases (approximately 85%) are classified as mild. The following observation from a German study reinforces the fact that most cases are mild: “All but 6 [of the 225 men diagnosed with hypospadias] were not aware of any penile anomaly, all but 1 homosexual patient have fathered children… All patients participated in sexual intercourse without problems and were able to void in a standing position with a single stream.”

Hypospadias can cause the head of the penis to be more mushroom shaped and it can also effect the part of the foreskin that’s on the underside of the head of the penis. Chordee can also occur, which is when the head of the penis is bent downward more than usual. One study found that about half of the penises of young men with hypospadias were smaller than average either when flacid, erect, or both.

Most men with hypospadias have a medical history where they had to have their penis repeatedly inspected and examined by this doctor and that. And boys with hypospadias are often subjected to unnecessary surgeries. These surgeries often cause damage that will require follow up surgeries. While medical intervention is sometimes helpful, there are plenty of males who would have been far better off if their penis had been spared the surgeon’s knife. For many men, it’s the surgeries they endured as children rather than the hypospadias that have caused the most problems.

Men with more severe forms of hypospadias will often feel like they’ve got this horrible secret in their pants. So aside from the unnecessary surgeries, the real damage from hypospadias is the shame and aloneness that a guy can feel when he’s growing up. One of the reasons for feeling so different is because he’s sometimes got to sit down to pee, given how the pee shoots out the side of his penis instead of the end. He knows he’s different from other males, and sometimes lives in terror that others will find out and make fun of him.

As is the case when any kid grows up feeling his body is defective, the most important issues to deal with are often the psychological. Men with hypospadias usually feel great emotional relief when they can meet and talk to other men who have the same condition, especially the small minority of men whose hypospadias has resulted in substantial deformity of their penis. Fortunately, the Internet is making it easier for men with hypospadias to connect with other men who have hypospadias.

As for sex and relationships, hypospadias is often a minor birth defect that can loom far more massively in the mind of the man who’s got it than in mind of a potential partner. There is nothing about hypospadias that makes a man any less of a man, or any less of a lover. As one female reader said, “I can name you hundreds of other things women are more concerned about in a man than if his pee or cum shoots out straight or from the side–most women wouldn’t give a rat’s ass. Only guys worry about things like that.”

There’s no reason why a man with hypospadias can’t become a father, so birth control is just as necessary as with any other guy. The urethral opening for men with hypospadias is sometimes bigger, which can make a man more prone to urinary tract infections. So drinking extra water and peeing after sex might be a good habit to get into.

Men with hypospadias recommend that you tell a partner about your hypospadias sometime after you’ve gotten to know each other but before you’ve got your hands in each other’s pants.

Parents should discuss the condition with their sons who have it, offering reassurance and helpful information. And I can’t suggest enough that any parents who are considering surgery for a son with hypospadias first read this article by medical ethicist Alice Dreger.

Helpful Resources:

An excellent resource is The Hypospadias and Epispadias Association.

Be sure to dread an article by Alice Dreger titled Do You Have to Pee Standing Up to Be a Real Man?

Hypospadias UK is also a very helpful website covering everything from causes to emotional consequences, but their explanation of possible sexual side effects is seriously wonky and appears to be straight from the early 1900s.

The image is by Daerick Gross Sr. from the Guide To Getting It On.

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