Emotional Aspects

• Will my son have normal sexual and psychological functioning after surgery?

It is worth to discuss this according to the degree of hypospadias:

Children with glanular/distal or mild forms of proximal hypospadias is one group of patients. The other group is patients with severe forms of proximal hypospadias, or patients who had severe complications and required several complex operations to correct the problem.

Two studies have shown no difference in the number of sexual episodes or their perceived quality between hypospadias patients, successfully operated, and average men without hypospadias. There was no significant difference in the ages at which boys started masturbating, necking or having sexual intercourse.

For patients with severe complications of hypospadias that requires several complex operations there is a correlation between the severity of complications and dissatisfaction with the surgical outcome and dissatisfaction with sexual performance.

Patients with  severe forms of proximal hypospadias and gonadal anomalies should be evaluated as patients with intersex.

In general average teenagers without any sexual anomalies have worries about their sexuality and that is quite normal. However when there is any penile anomaly the anomaly is consider to be the cause, whether it is true or not.  In other words it is difficult to assess if the teenager worry about sexuality is related to hypospadias or not.

In terms of episodes of sexual activity, number of partners, sexual problems and libido there is no significant differences between hypospadias patients, successfully operated, and average men without hypospadias. Similarly, there is little difference in the age of sexual debut compared with either controls or established community norms.

Penis size may be a cause of dissatisfaction. In general, penile size is a source of anxiety in many normal adolescents. Limited research is available on the relation of penile size to sexual satisfaction. Some studies showed that patients with micro penis have intercourse that is satisfactory to themselves though the opinions of their partners were not investigated.

To have proper assessment and evaluation one needs long term follow up studies. For patients with hypospadias, this means 20-40 years follow up studies. The problem with hypospadias is that 30-40 years ago, surgeons were using techniques that are obsolete now . This means that the available long term follow up studies in hypospadias are of little value.

However, some of those long term follow up studies based on interviews with patients who had surgery performed several decades ago showed that certain psychological and psychosexual problems can arise from hypospadias, mostly elated to the perception these patients have of their genitals.

A common complaint of patients with problems concerns the lack of information and follow-up after surgery, which can affect the lives of some of the patients just as much as aesthetic or functional factors. Educational support may help those who have problems to accept and come to terms with hypospadias and leading to a better psychological and sexual adjustment in later life.