Men With Hypospadias

If your child has hypospadias diagnosed at birth or your child had hypospadias surgery as an infant, one thing you might need to consider – even though it might seem like a long way off – is the impact on his fertility later in adult life.

If you’re an adult living with the affects of hypospadias and you are now considering starting a family, this could be the first time you’ve considered whether this condition will cause any fertility problems that will affect your ability to have children.

In this article we will explore some of the challenges you might face and why they might occur.

What is hypospadias?

Hypospadias is a congenital condition or birth defect, meaning that it is present from birth. It is more common in some families and in babies that are born premature (under 37 weeks of pregnancy).

The tube from the urinary bladder, which carries urine and semen to the tip of the penis, is known as the urethra. The point at which it exits the penis and the body is known as the urethral opening.

In boys born with hypospadias, the opening of the urethra is in the wrong place and is not located at the tip of the penis, as it should be. Instead, it’s located on the underside of the penis, anywhere from the head of the penis to the scrotum.

Hypospadias types

There are different degrees and type of hypospadias. The classification is based on the exact location of the urethral opening. The severity of hypospadias will depend on the location of the urethral opening.

The various types are:

Distal hypospadias. The opening of the urethra is located near the head of the penis. This is also referred to as anterior
Proximal hypospadias. The opening of the urethra is located somewhere on the penile shaft or mid-section of the penis
Scrotal or perineal hypospadias. The opening of the urethra is located where the base of the penis and the scrotum meet.

For more detailed information on this condition, please read our article What Is Hypospadias? All You Need To Know.

What problems can hypospadias cause?

As the urethra is a crucial component of both the urinary and reproductive systems, common problems associated with the condition include:

Abnormal urinary stream and flow; urine does not come out of the tip of the penis
Curving of the penis (chordee); this might be more apparent during erection and can impede sexual function
Decreased penile length; men with hypospadias often report dissatisfaction with the length of their penis
Pain or difficulty with erections
Difficulty with penetration or sexual function; it might not be possible to penetrate during sexual intercourse
Infertility requiring fertility treatment; men with hypospadias are more likely to receive a diagnosis of male infertility than men without the condition
Abnormal appearance of the foreskin
A higher likelihood of being born with undescended testes, where one or both of the testicles do not descend in to the scrotal sac
Impact on social life or emotional long term affects, including fear of intimate relationships and anxieties relating to penile size or appearance.

If left untreated, hypospadias can cause problems with the flow of urine or semen, or difficulties during sexual intercourse, affecting sexual life or sexual behavior.

Many hypospadias patients experience problems in their sexual life, especially if the penis is significantly curved. The curve of the penis might make it difficult, or mechanically impossible, to penetrate during sex; ejaculation problems can make sex more challenging.

Both of these difficulties can have an impact on an individual’s sexual and social life as well as on his physiological well being.

Does hypospadias affect erections?

Hypospadias can cause difficulties with erections and sexual activities. For some men, erection might be difficult to maintain or might be painful.

Some men will experience chordee, or a curving of the penis, especially when it’s erect. If the penis is significantly curved, it can cause problems during intercourse. For some, it might be mechanically impossible to achieve penetrative sex, due to the curvature of the penis.

Can hypospadias correct itself?

Hypospadias will not resolve by itself. In mild hypospadias, however, surgery might not always be indicated.

The need for corrective surgery will depend on:

Symptoms experienced
The baby’s age
The baby’s health
Severity of hypospadias.

How is hypospadias treated?

Hypospadias is a condition that will not resolve on its own, and is not a condition that a male infant will grow out of. If treatment is needed, the only option is genital surgery.

Hypospadias surgery

In most cases of hypospadias, patients need to undergo corrective surgery to ensure normal function and appearance of the penis.

The aim of successful hypospadias repair, in addition to a normal urinary stream and penile appearance, is a normal sex life, with normal erection and ejaculation.

During hypospadias surgery, the goal of the repair is to achieve a straight penis and correct the positioning of the urethra at the tip of the penis.

Hypospadias repair is usually performed on children between 6 and 24 months of age, when penile growth is minimal. Surgery can be performed later and even into adulthood; complications following the operation, however, are more likely to occur in adults.

For some patients with severe hypospadias, more than one surgery might be required.

Hypospadias correction is usually very successful. Normal urinary and sexual function should be achieved following hypospadias repairs.

Complications with hypospadias repair

Surgical procedures always involve an element of risk, however small. Certain complications are common to most procedures but need to be fully understood prior to consenting to any surgical procedure.

Common complications in patients following hypospadias surgery include:

Infection
Bleeding
Poor healing
Discomfort, pain or swelling
Narrowing of the urethra or problems passing urine
Abnormal appearance of the penis.

If you have any concerns following your hypospadias repair surgery, speak to your doctor and be sure to attend all of your follow up appointments.

Does hypospadias affect fertility?

Young men with hypospadias might have fertility problems associated with complications caused by the condition and with the testes.

Research shows that hypospadias has reproductive consequences. This could be as a result of problems with erections, penetration or ejaculation, or as a result of undescended testicles, which can lower sperm count.

Often, hypospadias results in problems with ejaculation. Depending on the location of the urethra, it might not be possible for sperm to enter the vagina during sex.

Reduced fertility might also be due to the underlying cause of hypospadias or a result of complications following hypospadias repair.

Hypospadias patients have an increased risk of receiving a diagnosis of male infertility or impaired fertility, and are more likely to need assisted reproductive techniques (ART) in order to have children.

In one study, however, it was found that fertility problems were most significant in men with a proximal hypospadias, and nearly non-significant in those with a distal hypospadias.

Can a man with hypospadias get a woman pregnant?

Despite the additional challenge, it is still possible for a man with hypospadias to get a women pregnant, and for them to have their own biological children. Fertility potential will depend on the severity of the condition.

Although impaired fertility is more common in men with hypospadias, compared with the general population, a more accurate analysis of fertility potential should be performed by semen and hormone analysis.

If you’re planning to start a family or considering it, speak to your doctor and discuss your best options.

Is hypospadias associated with other defects?

Hypospadias is sometimes accompanied by other types of malformations that can compromise male fertility, such as hidden or undescended testes, known as cryptorchidism.

Towards the end of pregnancy, as the baby is growing in the womb, it’s normal for the testes to descend from the abdomen to the scrotum. Sometimes, one or both testes do not descend before birth and, therefore, some male infants are born with undescended testicles.

In most cases the testes will drop by the time the baby is 6 months of age. If they have not descended by 6 months, they are unlikely to, and your baby’s care provider will probably recommend surgical techniques to treat the condition.

Undescended testicles at birth – is it serious?

Shortly after birth, it is sometimes discovered during a physical examination, that your baby’s testicles have not yet descended. This is relatively common, and even more common in infants who are born early. This is not painful for your baby and is not a cause for any immediate concern.

However, the situation should be monitored by a doctor. If the testes have not descended by 6 months of age, they are unlikely to, and treatment might be recommended. This is because boys with untreated undescended testes have a higher chance of fertility problems and an increased chance of developing testicular cancer.

It was previously thought that surgery for undescended testes should be performed prior to the onset of puberty; however, newer research suggests that early treatment reduces the risks of fertility problems and testicular cancer. Surgery for patients is ideally carried out before 12 months of age.

Does hypospadias cause cancer?

Hypospadias is not a direct cause of cancer; however, boys with hypospadias have an increased risk of developing certain types of cancer, including testicular cancer.

As with most cancers, the exact cause is unknown and is likely to be a combination of genetics and endocrine (hormonal) and environmental factors. However, according to Cancer Research, there are some risk factors that increase the chances of developing cancer.

The risk factors are:

Abnormality of the penis and urethra (hypospadias). Boys with hypospadias are more likely to develop testicular cancer as an adult
Undescended testicles (cryptorchidism). Sometimes, surgery is needed to bring down the testicles if they haven’t descended by the time of birth. In males where the condition is left untreated, or in adults who have not been operated on before the onset of puberty, there is a higher risk of developing testicular cancer
Abnormal cells in the testicles. Having abnormal cells in the testicles doesn’t equate to testicular cancer but, if left untreated, cancer can develop
Family history. Having other adult male relatives with testicular cancer increases the risk of developing it yourself
Previous testicular cancer. If you have already had testicular cancer, you have a higher chance of developing it in the other testicle
Ethnicity. In the UK, white males have a higher chance of developing testicular cancer than men of other ethnicities.