Hypospadias is, in simple terms, an imperfect formation of the urethra and a misplaced opening on the penis for urine and semen.
Wikipedia has a great article on Hypospadias. It's a clinical read, and gives the basics. This pictorial representation comes from there.
|This file is made available under the Creative Commons CC0 1.0 Universal Public Domain Dedication.
The person who associated a work with this deed has dedicated the work to the public domain by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.
This file is sourced from Wikimedia Commons
Wikipedia, and, through it, Wikimedia Commons are excellent sources of one of the key things, images of the affected part. Commons has a category with a lot of pictures of adult Hypospadias, none of which are erotic, and none of which can be judged safe for work. Looking at these pictures I now understand the technique used in my own rather unpleasant urethroplasty. The surgeon created an artificial Hypospadias about 3cm long in a four hour operation, and then sutured it into a tube three months later in a further four hour operation. The plastic surgeon I was referred to was a pioneer in the surgical rectification of children with Hypospadias.
It seems he had a consuming interest in the penis, rather too consuming for his career. Pity; he was a good surgeon. And I do think a man who is interested in his work is likely to do a better job.
Those wanting to learn more about reconstructive surgery in a technical way should start by reading what Wikipedia has to say about urethroplasty. My own thought is that this process is likely to be far easier in a younger patient. Do not delay if surgery is your chosen route, but read Sahypo's thoughts below.
This picture, released to us by, and © Sahypo, is an adult penis with a mild hypospadias. Several things are interesting about this, not least of which is that aiming for the toilet while standing up must be next to impossible. To eyes accustomed to the unaffected penis this looks ugly, but, be reasonable, some folk find any penis ugly. So, get over it.
What it does is looks to be potentially troublesome. A regular penis, circumcised or left natural, has defences against the ingress of dirt. Look at this one. Intuitively one can see that a large opening is likely to allow all sorts of material in. It says at once that the use of a condom for anal sex is probably a must, and not just for prevention of fæcal material entering the urethra. Look at the exposed additional mucous membrane inside the opening to the urethra and recognise that HIV infective agents will cross this barrier with ease (0.9 probability).
If we see one of these in the locker room, we stare. When I was between operations with my episode of having my dick filleted I was not shy. I went to beaches where clothing was optional and I opted not to wear them. Now, even if folk were not staring I felt as if they were. It didn't spoil my beach time, but it made me think about myself more. Now be the person being stared at (in your head!). Being stared at isn't pleasant. Neither is catching someone looking away suddenly! So, use good locker room etiquette. Have a conversation at eye level!
What about sexual sensation?
It's likely that this will be similar to the same penis had it not had hypospadias. But the first penis picture, the one showing an example of hypospadias, shows the possible absence of, or only the remnant of, the frenulum, or, to give it the full title, the 'frenulum of prepuce of penis'. This next picture of an 'ordinary' penis, released into the public domain via Wikimedia Commons, shows the frenulum of an uncircumcised penis. The article it is used in states, correctly:
The frenulum and the associated tissue delta on the underside of the penis below the corona has been described in sexuality textbooks as "very reactive" and "particularly responsive to touch that is light and soft". The "underside of the shaft of the penis, meaning the body below the corona" is a "source of distinct pleasure".
What this means is that the owner of the hypospadias affacted penis may be at a huge perosnal sexual disadvantage compared to the owner of the regular version. The thing is, he won't know any different. For him it's fine. It's just like the men circumcised as babies. They don't know what they are missing. They are fine. Oh, want more frenulum pictures? Wikimedia Commons has loads.
Only the owner of the penis concerned can tell you what his sexual sensation is. It is perfectly possible that my untutored guess about the first gentleman's frenulum is absolutely the reverse, and that he has "twin" frenulums (frenula?) and shedloads of sensation. That can also be a disadvantage! Who said sex was simple?
Remember, whatever that sensation is, it is normal for the owner of that penis, just as your penis is normal for you, and your child's is for your child, and your lover's is for your lover. Sensation is unique to an individual and variable. I wonder if it follows a normal "Bell End Curve"? Since each person's experience is unique, how would it ever be able to be measured? Time to orgasm? If so, under what circumstances?
Above, those are my thoughts. Below, Sahypo has contributed a lot more. The following text is © Sahypo. The key with hypospadias, for yourself or for your chid, is to think a lot and act a little.
Hypospadias is a birth condition in males in which the urethra does not exit the penis in the typical location, on the head, or glans of the penis. If you have hypospadias, you are probably already familiar with most of the dry and statistical information available on the internet, and are interested in learning what isn't covered.
Perhaps you are a new mother, and have just experienced that chat with your OB/Gyn that went like "Your baby boy is healthy and doing fine, but------". Now you have just learned a new word for the first time in your life, and don't know what to do.
What I would like to do in this article is chat with you and give you some perspective from a guy with hypospadias, who wishes to share what I can with both other males with the condition, and parents coming to grips with this diagnosis in their sons.
Moms will often write to tell me the following -
"My doctor says my son must have surgery, or he won't have normal function or socialization"
Mom, please take a look at the illustration of the three penises above…The great majority (about 65 to 70 percent) of men and boys with hypospadias are born with the least severe version, as shown on the left. What I am about to say is for those who have a penis like the one on the left, are able to pee in a straight stream, and have an erection without excessive chordee; I will get to chordee in a bit… For cases like I have just described, surgery is an option, but not necessary. A very high percentage of mild hypospadias cases are not operated, and we live just fine with it. Mild Hypospadias is an interesting visual difference, but not a functional issue. To choose no surgery is just as valid a choice, as opting for it.
As we move to the center picture of midshaft hypospadias, and the scrotal variety shown on the right, the need for surgery becomes more obvious. Yes, it is possible to go through life with a scrotal hypospadias, but most children this severely affected undergo corrective surgeries. Fortunately, this variety of hypospadias represents around 10% of all cases. Functionally, people with hypospadias this severe who do not have surgery have to sit to pee, which can be extremely embarrassing to a boy, and insemination would be a problem, although it is possible.
Chordee is a curvature of the erect penis that often accompanies hypospadias, and if it is very prominent, it can interfere with intercourse. Chordee can be a justification for surgery on a penis with very mild hypospadias that otherwise would have been left as is. It is also important to remember that most penises in general have some chordee, even without hypospadias. Whether chordee will be a problem or not depends upon the degree.
"I have been told not to circumcise my son so the tissue can be used for repair"
This is the standard thinking at this time, since it is the best tissue available. That being said, it is just as possible to operate on a circumcised penis with hypospadias, since almost all repeat surgeries fall into this category. We will discuss risks and complications in a moment, but the take-home lesson here is that all is not lost if no foreskin is available.
Cosmetically, the vast majority of children born with hypospadias have a partial or hooded foreskin. Meaning that the foreskin, like the penis itself, is deficient in development on the lower surface. Such a foreskin is like a flap laying on top of the penis, rather than a smooth tube encasing it. For this reason, some parents choose to remove the foreskin, even if repair of the hypospadias is not planned. The child will look like any other circumcised male in situations where nudity is common, such as locker rooms, pools, etc.
"What are the risks of surgery, and what are the success rates? How do I find the right surgeon?"
ANY surgery carries risks, such as bleeding, scarring, infection, wound breakdown and loss of sensitivity.
There is also no guarantee that one procedure will be all that is required. Repeat procedures are common in this specialty, and hypospadias surgery is a specialty. Remember that you take the same risks in surgery regardless of the severity of the case. The relative risks you run are higher when repairing a mild hypospadias, for mere cosmetic gain, than those who are seeking extensive urethral construction for scrotal hypospadias. The guy with the severe case may have his life changed, perhaps by being able to function sexually for the first time.
I would also caution that if you are an adult who is needing a revision of a childhood hypospadias surgery, that you DO NOT schedule surgery with your pediatric surgeon…Adult revision and repair surgery for hypospadias is not the same as pediatric surgery, and you need a specialist who does procedures on adults.
You should look for a surgeon who does lots of cases like the one that YOU or YOUR SON has. Each case is unique, and you want someone who is familiar and comfortable doing procedures on the same type of case.
Asking a surgeon about his success rate is problematic, in that the terms require definition. Most surgeons who take more complicated cases are also going to have more complications, so merely looking at complication rates doesn't tell the complete story. You should ask him what the most common complications HE deals with are, and have a frank discussion about HIS numbers, not some general statistics pertaining to the technique he uses. Be aware that a lot of stuff on the internet is old, maybe inaccurate, and can be taken out of context by the average person. Some of the worst people surgeons have to deal with are parents who learned everything they "know" about hypospadias from the internet.
It is also helpful to be honest about your expectations for the outcome of the procedure. His expectation and benchmark might be simply to give his patient a straight penis for intercourse, and the ability to urinate standing in a neat stream. For decades in fact, this was the standard, and a lot of really ugly penises that worked okay and looked awful was the result. If you want you or your son's penis to look like it never had anything done to it, that may not be realistic, but it is something that you need to discuss before committing.
"Did my mother cause my hypospadias, or Did I cause my son to be born like this?"
We really do not know what causes hypospadias, and it may be that we never do find a smoking gun. Since most cases of hypospadias are isolated, heritance is unlikely. However, there are familial cases where hypospadias has been "handed down" for five generations in one family I am aware of. The truth is that hypospadias is probably multi-causal, and over 200 genetic syndromes list hypospadias as a feature.
Conjecture rages about the effects of plastics and environmental toxins and their relationship to hypospadias, but there is always a problem with those arguments; if all the male children of a certain age and geographic proximity are assumed to be equally exposed to whatever is causing hypospadias, why are not all the boys affected? In my own situation, I never saw another person in my peer group with hypospadias, and in the days of public school showers after gym class, I saw them all.
We know from animal studies that drugs like Finasteride and Diethylstilbestrol (DES) have a proven track record for causing hypospadias, and that fertility procedures like IVF have a reported incidence rate of hypospadias that is above the normal. Every other conjectured cause like vegetarianism or soy estrogens have weak or inconclusive evidence to support these theories.
"I hear horror stories about men growing up with this…I want to fix this before he's old enough to remember"
Umm, good luck with that. I can tell you that most boys with hypospadias that was corrected in infancy will tell you they know the difference. I have no evidence to support this, but most of us in this community feel that what caused our hypospadias also changed something in our brains as well. We just know… Like I said in the beginning, there is no rush, and plunging ahead into surgery so the baby won't remember is probably basing such a decision on false assumptions, especially if your health care provider is pushing this narrative.
There does seem to be a time window that is best for surgery, but for a very practical reason. Scheduling surgery before the baby begins to crawl is much easier for all concerned during the recovery. Eighteen months to two years is the worst time…children are uncooperative and obstructionist by nature at this age, and the recovery can be horrendous for the whole household.
I will tell you one recipe that will guarantee an unhappy child and a maladjusted adult; shame, secrecy and isolation. Boys who grew up in households where discussions about this issue didn't take place, or were told to hide the family secret at all costs are the ones who pay the price, suffering dysfunction and emotional disturbance. These are the men who, as children ,were put in open hospital wards with little or no explanation, then suffered the abuse of propriety and privacy that a lot have written about. After the surgeries, it was assumed by the parents that all was well, when in a lot of cases, all was not well in the least.
Open and honest communication without shame or embarrassment is the way to teach a child to maintain perspective about a common and usually minor birth difference, and keep it from becoming something overwhelming.
The love and affection of a father is vital. It is easy for a boy to feel that his masculinity is compromised, and a father's affirmation of his son's maleness is of immense importance to bolster the child's self image.
Children whose fathers are fully engaged in their boy's lives and able to discuss how the child feels about hypospadias and the medical intervention in his life if there is any, do much better socially and emotionally.
"I'm a young guy who wants to have a sexual relationship, but I'm afraid to let a partner know about this"
There is so much more to great sex than the size or shape of your penis. As a young man becoming sexually active, I also felt a great degree of inadequacy, due to my differences. What I learned very quickly is that the most important things you do with a partner is put their pleasure first, and communicate. Learn the things that they like and get very good at doing those things. If you consider what you can give your partner, and not what you can get, you are well on the way to being a great lover. There are lots of men with normal genitalia who are lousy at sex; I always felt that I had to be twice as good as the man with the "typical" penis…That motivation to try harder to please and pleasure whom you are with is much more important than what your penis looks like.
Two more things to think about:
The way you process the feelings you have about hypospadias is up to you, but this is not going to be a huge issue for your partner, unless you make it so overwhelming that they leave you because of the emotional baggage becomes too much. Chances are that your partner has a "normal" penis, or she has no penis at all; either way, they don't have the emotional investment in hypospadias that we do.
You can choose two paths; one path is to protect your "secret" at all costs, including that of denying yourself the closeness and love of a partner in your life, or you can choose to take the risk of trusting another with your vulnerability and opt to get up and dance in this life with what God gave you…
I sincerely hope that you decide to dance…
Comments, Questions? Reach me at firstname.lastname@example.org