Hypospadia is a condition in which the opening of the urethra – which is normally at the top of the glans – is located on the underside, the shaft of the penis or even in the scrotum. In addition the foreskin on the underside of the glans is missing, and the erect penis is sometimes also bent. Approximately i in 300 males is born with this abnormality. The
cause of hypospadia is very probably a relative testosterone deficiency between the sixth and thirteenth week of pregnancy.

To enable a patient to urinate standing up and function normally sexually, the end of the urethra must be reconstructed and the penis stretched. In the past children with this condition were not operated on until they were older, but today urologists prefer to perform the operation before the child enters its third year, thus limiting the psychological trauma of hospital admission as far as possible. For the manufacture of a new section of urethra use is made of the inner leaf of the foreskin. If the foreskin has already been removed, one can also use mucous membrane from the cheek or lip. Scars, the relatively short penis length and the abnormal shape of the glans mean that some boys, particularly in their adolescence, are not really satisfied with the result of the operation. The urologists who operated on them usually are, but they know that their options will always be limited. Doctors can’t really improve on the existing organ. It is important to make it quite clear to patients that correction of hypospadia will not lengthen the penis. Adolescents or adults complaining of too small a penis in particular should be offered help by a sexologist.

A very special form of hypospadia is mika. As an initiation ritual at the onset of puberty, the male inhabitants of the island of Mangaia in the Pacific have their urethra split open from the tip to the scrotum with a narrow incision. It is no accident that mika means ‘the terrible ritual’. The procedure prevents semen from finding its way into the vagina during intercourse – a crude form of contraception! Australian Aborigines, as it happens, once had the same custom.

As a last resort in the event of several failed urethra operations, urol­ogists sometimes go a step further by relocating the outlet of the urethra between the scrotum and the anus. Men who have had this treatment are therefore obliged to urinate in female fashion, namely squatting.