Symptoms and causes

Symptoms

In hypospadias, the opening of the urethra is located on the underside of the penis instead of at the tip. In most cases, the opening of the urethra is within the head of the penis. Less often, the opening is at the middle or the base of the penis. Rarely, the opening is in or beneath the scrotum.

Signs and symptoms of hypospadias may include:

  • Opening of the urethra at a location other than the tip of the penis
  • Downward curve of the penis (chordee)
  • Hooded appearance of the penis because only the top half of the penis is covered by foreskin
  • Abnormal spraying during urination

When to see a doctor

Most infants with hypospadias are diagnosed soon after birth while still in the hospital. However, slight displacement of the urethral opening may be subtle and more difficult to identify. Talk to your doctor if you have concerns about the appearance of your child's penis or if there are problems with urination.

Causes

Hypospadias is present at birth (congenital). As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.

In most cases, the exact cause of hypospadias is unknown. Sometimes, hypospadias is genetic, but environment also may play a role.

Risk factors

Although the cause of hypospadias is usually unknown, these factors may be associated with the condition:

  • Family history. This condition is more common in infants with a family history of hypospadias.
  • Genetics. Certain gene variations may play a role in disruption of the hormones that stimulate formation of the male genitals.
  • Maternal age over 35. Some research suggests that there may be an increased risk of hypospadias in infant males born to women older than 35 years.
  • Exposure to certain substances during pregnancy. There is some speculation about an association between hypospadias and a mother's exposure to certain hormones or certain compounds such as pesticides or industrial chemicals, but further studies are needed to confirm this.

Complications

If hypospadias is not treated, it can result in:

  • Abnormal appearance of the penis
  • Problems learning to use a toilet
  • Abnormal curvature of the penis with erection
  • Problems with impaired ejaculation
Nov. 01, 2016
References
  1. Baskin LS. Hypospadias. http://www.uptodate.com/home. Accessed Aug. 14, 2016.
  2. Kliegman RM, et al. Anomalies of the penis and urethra. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed Aug. 14, 2016.
  3. Epispadias and hypospadias. American Urological Association. https://www.auanet.org/education/modules/pathology/penis-defects/epispadias-hypospadias.cfm. Accessed Aug. 14, 2016.
  4. Facts about hypospadias. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/birthdefects/hypospadias.html. Accessed Aug. 14, 2016.
  5. Bouty A, et al. The genetic and environmental factors underlying hypospadias. Sexual Development. 2015;9:239.
  6. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. July 26, 2016.
  7. Granberg CF (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 28, 2016.