Hypospadias is one of the most common developmental issues for a fetus in the United States. It affects approximately
If your child is one of those babies, it’s only natural to be concerned about next steps. Here’s everything you need to know about hypospadias, including what causes it, how it’s treated, and what your baby’s long-term outlook is.
Hypospadias is a congenital anomaly, which means it’s present at birth. It can affect any baby born with a penis.
If someone has this condition, the opening of their urethra, called the meatus, isn’t located at the tip of their penis. Instead, it’s located somewhere below the end of the penis and the scrotum.
In general, there are several types of hypospadias:
- Subcoronal hypospadias. This is when the meatus is in the distal position, which means it’s near the end of the head of the penis, but not at the tip. This type of hypospadias is the most common. It affects more than 80 percent of people with hypospadias.
- Midshaft hypospadias. This is when the meatus is located along the shaft of the penis in what doctors call a proximal position.
- Penoscrotal hypospadias. This is when the meatus is located somewhere near where the base of the penis and scrotum meet. It’s one of the most severe types of hypospadias.
- Scrotal or perineal hypospadias. This is the rarest form of hypospadias. It occurs when the meatus is located in the scrotum or behind the scrotum.
The most obvious symptom of hypospadias is that the meatus is not located at the tip of the penis but instead below the tip, along the shaft, or at the base of the penis. Its location determines the diagnosis.
Other symptoms include:
- A penis that slightly curves downward. This is called chordee. It occurs in about 15 percent of people with hypospadias.
- Trouble urinating. This happens because of the spraying of urine coming from other areas besides the tip.
- Incompletely formed foreskin. This means your baby may be born looking partially circumcised because the foreskin forms on the back of the penis but does not go all around.
- An undescended testicle. This happens when one or both testicles remain inside the body rather than descending into the scrotum, which is the skin sac that holds the testicles.
If not treated, hypospadias can also cause other problems, such as making it difficult to have sexual intercourse or pee while standing.
Both hypospadias and epispadias are congenital issues, but epispadias can affect any sex whereas hypospadias only affects those with a penis.
Epispadias is rarer than hypospadias: It affects 1 in 117,000 newborns with a penis and 1 in 484,000 newborns with a vagina.
In babies with a penis, epispadias can cause the tip of the penis to be split and opened, or it can cause the opening of the urethra to be located in another place on the penis.
In babies with a vagina, the opening of the urethra could be located between the clitoris and the labia, or even in the stomach area.
Doctors and researchers aren’t exactly sure what causes hypospadias, though research is ongoing.
However, experts believe hypospadias is likely caused by a combination of genetic, environmental, and hormonal factors that change or stop the development of the penis in utero, somewhere before or during the 5th month of pregnancy.
A pediatric urologist typically diagnoses hypospadias shortly after birth.
The doctor will examine the child, identify the meatus’s location, assess for penis curvature, and determine how severe of a case it is.
During this evaluation, the doctor may take measurements to help determine the best treatment option.
If your child doesn’t have any chordee (curvature to their penis) and their hypospadias is mild, with the meatus near the tip, they may not need surgery.
If the hypospadias is more serious, treatment usually involves surgery to help repair and rebuild the urethra so it extends to the tip of the penis. Any curvature of the penis will be addressed at the same time.
Your child should not be circumcised before this repair because the extra tissue may be needed as part of the procedure.
Although doctors aren’t exactly sure what causes hypospadias, there are some known risk factors, including:
- Genetics. You are more likely to have a baby born with hypospadias if another close family member with a penis had the condition too.
- Hormones. Because the penis and foreskin develop in utero with the help of hormones like testosterone, it is possible that environmental factors might affect these hormones and cause hypospadias.
- The pregnant parent’s age. Babies birthed by parents over age 35 are more likely to have hypospadias.
- In vitro fertilization (IVF) and some other fertility treatments. IVF and other fertility treatments may increase the risk of a baby being born with hypospadias.
- Premature birth or low birth weight. Babies born early or with low birth weight are more likely to have hypospadias.
In general, the outlook for children with hypospadias is good. Many children who have it repaired with surgery grow up to have a normally functioning penis.
However, as with all surgeries, complications can occur. Complications are more likely in the cases of more severe hypospadias.
Complications that can occur include:
- leaking urine or a new hole (called a fistula) forming in another place on the penis
- a large blood clot
- scarring in the channel or meatus, which makes it more difficult to urinate
- meatal stenosis, which is narrowing over time of the opening of the urethra
- permanent penis curvature
- a need for repeated surgery to repair complications
- a need for plastic surgery to repair cosmetic issues
The risk of complications is highest in the months following the surgery. Long-term checkups are generally needed to monitor your child’s penis and make sure that issues don’t develop as they grow.
Some children may benefit from meeting with a pediatric psychologist, particularly as they enter puberty, to help them manage and overcome any body image issues.
It can be scary to learn your child was born with a condition like hypospadias.
However, it’s possible to repair hypospadias with treatment. In many instances, your child will grow up to have a perfectly functional and typical looking penis.