Hypospadias is one of the most common developmental issues for a fetus in the United States. It affects approximately 1 in every 200 babies with a penis.

“It is natural for your child to be concerned about the next steps. Hypospadias are a topic that you need to know about, including what causes it, how it is treated, and what your baby’s long-term outlook is.”

Hypospadias is a congenital abnormality and can be present at birth. Any baby born with a penis can be affected.

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.

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 meatus is located at the base of the penis, not at the tip, as is the most obvious symptom of hypospadias. Its location is what 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.

Hypospadias can cause other problems, such as making it difficult to have sex or pee while standing, if not treated.

Hypospadias only affects those with a penis, whereas epispadias can affect any sex.

Epispadias is similar to hypospadias. In epispadias, the tube through which urine leaves the body is fully developed but does not form a tube. In hypospadias, the urethra is a tube but it does not reach the end of the 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.

Epispadias can cause the tip of the penis to be split or the urethra to be located in another place on the penis in babies with a penis.

The urethra can be found in the clitoris, labia, or stomach area in babies with a vagina.

Researchers are unsure of what causes hypospadias.

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 urologist diagnoses hypospadias after birth.

The doctor will look at the child, identify the meatus, assess for penis curvature, and determine how severe of a case it is.

The doctor may take some measurements to help determine the best treatment option.

If your child does not have a congenital penis, they may not need surgery.

If the hypospadias is more serious, surgery to repair and rebuild the urethra is usually the only option. The penis will be addressed at the same time.

The extra tissue may be needed for the procedure, so your child should not be circumcised before that.

The surgery is generally outpatient and usually performed when the child is between the ages of 6 months and 18 months, though some surgeries may be performed in children as young as 3 months.

“There are some known risk factors for hypospadias, even though doctors don’t know what causes them.”

  • 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.

The outlook for children with hypospadias is good. Many children who have their penis repaired have a functioning penis.

Complications can occur with surgeries. Complications are more likely in the case of more severe hypospadias.

Complications can occur.

  • A hole in the penis is called a fistula.
  • A clot.
  • It is more difficult to urinate because of the scarring in the channel.
  • The meatal is narrowing over time.
  • The penis is permanent.
  • A need for more surgery to fix things.
  • Plastic surgery is needed to fix issues with the skin.

“The months following the surgery are the most risky. Long-term checks are needed to make sure your child’s penis doesn’t get bigger.”

Some children may benefit from having a meeting with a psychologist to help them manage and overcome body image issues.

It can be frightening to learn your child was born with a condition.

It is possible to repair hypospadias with treatment. Your child will grow up to have a penis that is functional and typical.