I’m a young man with hypospadias/epispadias. I want to be romantically involved, but I’m afraid I’ll be rejected because of my condition. What should I do?

Your condition may not be as obvious to other people as it is to yourself, even if your potential sexual partner has had sexual encounters with other guys before. The biggest difference in your penis is most likely cosmetic, and most partners will not be very concerned with the cosmetic appearance of your penis. Nevertheless, it would be wise to tell your partner briefly about your condition a bit beforehand (but not on the first date) just to avoid surprises. However, if you make a big deal out of the condition, it is more likely that your partner will make a big deal out of it too. Simply mention that you were born with a minor birth defect on your penis (even severe hypospadias/epispadias is a minor birth defect compared to most), so it may appear a bit different. Your partner may be curious and ask questions, and that’s fine. Answer the questions simply and honestly without dwelling on the subject. It is very unlikely that a partner will reject you because your penis is different, but they may very well reject you if you seem obsessed with the subject.

Will I be able to father children?

In order for a man to be able to impregnate his partner, two basic events must occur: (1) the man’s testes must produce adequate numbers of viable sperm; (2) semen (containing the viable sperm) must be deposited into the woman’s vagina so it can migrate to the fallopian tube where fertilization occurs. There is no medical evidence that men with hypospadias/epispadias are more likely to be infertile (event #1). However, it may be difficult to achieve event #2 if the urethral opening is positioned so that semen does not enter the vagina. Such a situation does not preclude someone from being able to father children, however. Artificial insemination could be used to transfer the man’s semen into the proper location for fertilization. Alternatively, some people claim to have had success with “do it yourself” artificial insemination by manually transferring semen or using a device such as a turkey baster.

I have hypospadias/epispadias. Are there any special hygiene concerns?

Yes. Men with hypospadias/epispadias may have a larger urethral opening than average, so wash your penis very carefully so that irritants such as soap do not enter the urethra. Other irritants that may enter the urethra include spermicides, so it may be wise to avoid using sexual lubricants that contain spermicide. Additionally, you may have a higher risk of contracting HIV or other sexually transmitted diseases, especially if your urethra is irritated and inflamed, so condoms are especially important. You may also be at greater risk of contracting urinary tract infections, so consider preventive measures such as drinking plenty of fluids, drinking cranberry juice, and urinating when you have the urge without holding it in for extended periods of time.

Should I have surgical correction as an adult?

Surgery is often more complicated for a teenager or an adult than it is for a child. Take the time needed to research the issue thoroughly and talk to different physicians. Always seek out second and third opinions, and ask each physician about the expected benefits and risks of surgery and the consequences of not performing surgery, as not every physician may offer the same advice. Evaluate your motivations for surgery, whether improvement of cosmetic appearance or improved function, and determine how likely surgical correction will meet those goals. Consider possible side effects, including reduced sexual sensitivity, and weigh the possibility against likely improvement from surgery.

What does corrective surgery involve?

The precise method of surgery is constantly evolving, and there are several different surgical techniques for hypospadias and epispadias. However, there are two basic goals of corrective surgery: (1) to straighten the penis (if chordee is present) and (2) to extend the urethra to the tip of the penis. Straightening the penis typically involves cutting tissue that is pulling on the tip of the penis and causing it to bend toward the shaft. Extending the urethra can be more complicated, depending on the severity of the condition. Tissue grafts (often from the foreskin) are typically used to create an artificial urethra that will be inserted inside the penis, joining the existing urethra to a man-made opening created at the tip of the penis. Mild cases may be treated in a single operation, whereas more severe cases typically require multiple surgeries.

What are the possible risks and side effects of surgery?

In addition to the risks associated with any surgery, the most common potential problems include urinary tract infections, stricture of the urethra (narrowing of the urethra typically caused by scar tissue which restricts urine flow), fistulae (holes that may form along suture lines through which urine may leak), hair growth inside the urethra (if the grafted tissue contains hair follicles), and formation of scar tissue which may lessen sexual sensitivity. In some cases, a surgical operation may fail completely, in which case the grafted tissue will have to be removed, and the operation repeated.

How do I choose a good surgeon?

The only way you can find the right physician for you is to talk to several in person. Even if the first one you talk to seems perfect, get a second (or third) opinion. Ask each surgeon how often he/she performs corrective surgery on men and older boys whose condition is similar in severity to yours. Get precise numbers (once per week, twice per month, etc.), not vague terms like “often” or “all the time.” Ask whether the surgeon will actually perform the surgery himself/herself or will simply supervise a less-experienced surgeon. Ask how many stages (separate operations) will be required for repair and how much recovery time there will be between operations. Find out how frequently the surgeon’s operations on men and older boys fail and need follow-up surgery. Again, ask for precise numbers, not subjective terms like “rare” or “occasionally.” Ask if the surgeon has any before-and-after photographs. Narrow down your choices to the surgeons with the most experience treating hypospadias and epispadias and the lowest failure rates. Then consider which surgeon you feel most comfortable with and are not intimidated by or afraid to question. Be wary if a surgeon makes promises that seem to good to be true. If one surgeon promises a one-stage repair whereas all the other surgeons predict a three-stage repair, ask probing questions to explain the discrepancy.