Thursday, March 16, 2023

What is hypospadias and how does it affect child rearing?

Malformation of the male urethra:

Hypospadias is a congenital defect defined as a malformation of the male urethra which is abnormally located at the lower end of the glans penis, on the underside of the penis, or at the junction of the penis and scrotum. Therefore, hypospadias can be categorized into anterior, medial, and posterior.

The severity of hypospadias depends on the location of the urethral orifice. In both cases, the man will find it difficult to have intercourse and ejaculate, and pregnancy in a natural way will therefore be complicated.


Hypospadias is an anomaly which appears from birth (congenital) and which is characterized by the fact that the opening of the urethra is at a different place than the end of the penis. Hypospadias is also usually associated with a malformation of the foreskin and a curvature of the penis towards the belly. This type of penis is called congenital curved penis.

Due to this curvature of the penis, hypospadias is considered a cause of sexual dysfunction, as it can make sexual intercourse mechanically impossible. In addition, due to the abnormal position of the urethral orifice, ejaculation in the vagina is also hindered.

The frequency of occurrence of hypospadias is between 1 and 8 newborns in 1000.
Hypospadias has both aesthetic and functional consequences. Once the child is older, this malformation can even have psychological consequences.

On the other hand, hypospadias can sometimes be accompanied by other types of malformations that may compromise male fertility, such as cryptorchidism, the presence of hidden testicles and even the diagnosis of sexual ambiguity or pseudo-hermaphroditism must be ruled out. .


There are different types of hypospadias depending on the location of the urethral orifice. The further the urethral orifice is from the glans penis, the more severe the hypospadias. This is how they differ:

- Posterior hypospadias:

is the most severe form. This type of hypospadias appears in 20% of cases and the urethral orifice is very distal to the glans, in the area between the scrotum and the penis or at the base of the penis. Also, posterior hypospadias is accompanied by a very curved penis. This type of hypospadias is also known as penescrotal hypospadias.

- Medium (penile) hypospadias:

constitutes 10% of cases and is of medium severity. The orifice here is located in the central part of the penis, usually on the underside. This causes a certain curvature of the penis towards the belly.

- Anterior hypospadias:

also called glandular hypospadias. This is the most common type, present in 70% of cases. Also, this form of hypospadias is the most benign, since the urinary meatus is close to the glans penis. In addition, the penis has an aesthetically normal appearance and has practically no curvature.

The problems associated with hypospadias will be all the more serious if the urethral orifice is located behind.

Causes of hypospadias:

The exact reason for hypospadias is not known. However, most studies seem to indicate that this abnormality in the position of the opening of the urethra is caused by genetic factors in combination with environmental factors and certain medications. In addition, this malformation is dependent on androgens. Thus, among the causes that can lead to hypospadias, a genetic mutation leading to androgen receptor deficiency may be involved.

This mutation can be inherited in some cases, when a family member already has hypospadias. It is estimated that it is 20% more likely to appear in other members of the same family.

Disruption of embryonic androgen receptors by environmental factors is also thought to be one of the culprits. As well as hormonal treatment in the first month or first trimester of pregnancy or impaired testosterone synthesis.

- Risk factors:

Some factors that seem to increase the risk of hypospadias in children are:
  •  Mothers over the age of 35 with a high body mass index (BMI).
  •  Pregnant women thanks to assisted reproduction techniques.
  •  Administration of certain hormones before and during pregnancy.

However, the presence of these factors does not mean that the baby will have hypospadias. These are only factors that have been studied and appear to increase the risk.


Symptoms of hypospadias depend on the severity of hypospadias. In any case, the most common clinical manifestations associated with hypospadias are:
  •  Discomfort during erection.
  •  Urine does not come out of the tip of the penis.
  •  Difficulty maintaining direction of urine
  •  Difficulty in sexual relations.
  •  Abnormal appearance of the foreskin.

Due to ejaculation problems, the possibility of having children naturally can be complicated. Additionally, it will also be difficult for sperm to reach the uterus during intercourse.

Diagnosis and treatment:

The way to diagnose hypospadias at birth is by physical examination of the baby. If the pediatrician is unsure of the diagnosis, they may request further evaluation. In general, the treatment of choice for hypospadias is the surgical option. Due to the psychological impact that this anomaly can have on the child, most specialists recommend the operation at an early age, before 3 years of age.

In general, if the problem of hypospadias is corrected when the child is young, it does not need to influence adulthood.

Also, a micropenis can appear due to the curvature of the penis towards the belly. Therefore, during the operation, if necessary, the curvature of the penis can be corrected at the same time as the reconstruction of the urethra and foreskin. Sometimes penis growth can also be stimulated by hormone treatment.

As we have seen, there are different surgical techniques to resolve hypospadias. It is the specialist who will evaluate the case and decide which is the appropriate technique to treat the different aspects to be treated, the orifice, the curvature of the penis and the foreskin.

Hypospadias and fertility:

The concentration of male hormones involved in sperm formation and associated with male fertility may decrease depending on the location of the urethral orifice. Also, hypospadias causes ejaculation problems by preventing sperm from passing through the vagina. For these reasons, the likelihood of having a child with hypospadias is low.

MAP, like any medical treatment, requires that you trust the professionalism of the doctors and the clinic you have chosen. Of course, not all are the same. The Fertility Report selects the most beneficial clinics for you based on our rigorous quality criteria. In addition, the system makes a comparison of prices and conditions offered by different clinics to facilitate your decision-making.

However, if this birth defect of the location of the urethral orifice is treated properly at an early age, it usually does not lead to reproductive health problems in adult men.

Your frequently asked questions:

- How do I know if I have hypospadias?

By José Luis de Pablo (senior clinical embryologist).
Hypospadias is a birth defect in men, where the urinary tract is not on the tip of the penis. This duct may be in an area between the tip of the penis and the scrotum. Some hypospadias are milder or more severe.

- Does hypospadias cause male infertility?

By Dr. Mónica Aura Masip (gynecologist).
Hypospadias is the most common congenital malformation of the penis (1/300 males). It is usually diagnosed at birth during a physical exam and there are varying degrees. It is the ectopic opening of the urethral meatus.

Normally, this opening is located at the tip of the glans penis, but in patients with hypospadias, it is located between the glans and the scrotum, on the underside of the penis.

Hypospadias leads to problems with ejaculation, in some cases preventing the correct exit of spermatozoa, even after surgical correction.

If there is also a hormonal or karyotype alteration, there may be an alteration in the correct production of sperm.

All this means that the chances of having offspring are reduced.

- Is hypospadias hereditary?

By Marta Barranquero Gómez (embryologist).
The exact cause of hypospadias is not precisely known, but there is a link with genetics. For this reason, some studies show that hypospadias runs in families.

More specifically, the genetic cause of hypospadias would be a mutation in a gene, resulting in a lower concentration of androgen receptors. However, it is not possible to say that this congenital malformation of the location of the urethral opening is genetic.


Hypospadias can lead to cryptorchidism in humans, which can cause problems in having offspring.