Medically reviewed by
Dr Filip Vukasin, General Practitioner
What is hypospadias?
Hypospadias is a condition that occurs in males, where the opening of the urethra (the tube that carries urine from the bladder) is on the underside of the penis rather than at the tip.
In hypospadias, the urethral opening may be on the underside of the glans (head) of the penis, anywhere along the shaft of the penis, or in the scrotum or perineum.
There may also be a downward curve in the penis and an incompletely formed foreskin in people with hypospadias.
Symptoms of hypospadias
Signs of hypospadias include the urethral opening not at the tip of the penis, a downward curve of the penis and an incompletely formed foreskin.
Not everyone with hypospadias has symptoms but for some people, symptoms of hypospadias include:
How common is hypospadias?
Hypospadias affects around 1 in every 250-300 newborn baby boys in Australia. In most boys with hypospadias (75-80%) the urethral opening is on the underside of the glans or close to the glans on the shaft of the penis.
Hypospadias is the second-most common congenital abnormality in boys and the most common developmental condition affecting the penis.
Other developmental abnormalities of the genitals can occur with hypospadias, usually for more severe forms.
Causes of hypospadias
The exact cause of hypospadias is unknown, but it results from abnormal development of the penis before birth.
Hypospadias is more common in some families than others (on either the mother’s or father’s side), is linked to some genetic changes that affect hormone levels and developmental mechanisms, and occurs as part of many rare genetic syndromes. However, a clear genetic cause is only found in 30% of cases.
Hormonal factors, pollutants, in vitro fertilisation and a range of maternal factors have been associated with hypospadias but none of these factors alone causes it.
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Diagnosis of hypospadias
Hypospadias is usually diagnosed at birth, when the newborn baby is being examined.
Hypospadias treatment
Mild forms of hypospadias, where the urethral opening is close to its usual position, may not need treatment.
Reconstructive surgery to move the opening of the urethra to the tip of the penis is standard treatment for hypospadias. The operation is usually performed at 6-12 months of age.
For severe forms of hypospadias, where the urethral opening is towards the base of the penis or through the scrotum or perineum, more than one operation might be necessary.
Health effects of hypospadias
Most people with hypospadias do not have any other developmental condition. Occasionally hypospadias occurs in combination with undescended testes (cryptorchidism), which might result in further investigations or surgery.
Most people who have surgery for hypospadias have a penis that appears and functions normally but some (around 20%) need surgery or other procedures later to manage urinary complications or cosmetic issues.
While the long-term outcome of hypospadias repair is generally good, the condition can affect a man’s sense of self and sexual function.
People born with hypospadias have a higher-than-normal risk of androgen deficiency, type 2 diabetes, cardiovascular disease and some neurodevelopmental and psychiatric conditions. People born with more severe hypospadias may have reduced fertility.
What to do about hypospadias
People born with hypospadias should receive regular monitoring by a general practitioner during childhood, adolescence and into adulthood to make sure there are no complications.
