Hearing that your baby has hypospadias can be confusing and worrying. Many parents have never encountered the term before, and the idea of a condition affecting the genitals can feel especially sensitive. The good news is that hypospadias is relatively common, usually treatable, and most children who receive appropriate care go on to live healthy, active lives with normal urinary and sexual function.
This post is designed to help you understand what hypospadias is, how it is diagnosed, the treatment options available, and the emotional side of navigating this journey as a family.
Quick note: This article is for general education only and is not a substitute for medical advice. Always discuss questions and decisions with a qualified pediatric urologist or healthcare provider.
What Is Hypospadias?
More Than Just a Misplaced Opening
Hypospadias is a congenital (present at birth) condition that affects the male urethra. In a typical penis, the urethral opening is located right at the tip. In hypospadias, the opening is on the underside of the penis instead. It might be just slightly lower than normal, or it might be located further down toward the base of the penis or even near the scrotum.
This condition can affect:
- Where urine comes out
- The direction of the urinary stream
- The appearance and straightness of the penis
In some boys, the penis curves downward when erect (a curvature called chordee). In others, the difference is milder and mostly related to the position of the opening.
Hypospadias is not caused by anything a parent did or did not do. It develops early during pregnancy, when the tissues of the urethra and penis are forming.
Types of Hypospadias: Understanding the Spectrum
Doctors classify hypospadias based on where the urethral opening is located. This helps guide treatment decisions and gives parents a better idea of what to expect.
Anterior (Distal) Hypospadias
This is the most common form. The opening is located near the head of the penis:
- Glanular: at or very close to the ti
- Coronal: just below the rim of the glans
These forms often cause fewer functional problems and are sometimes mainly a cosmetic concern. Even so, many families choose repair to improve the appearance and urination pattern.
Middle (Midshaft) Hypospadias
Here, the opening lies somewhere along the middle of the shaft. This can affect how a child urinates, especially when standing, and may be more noticeable as he grows. Midshaft hypospadias usually requires surgical repair to straighten the penis if there is curvature and to move the opening toward the tip.
Posterior (Proximal) Hypospadias
This is the most severe category. The opening may be:
- Near the base of the penis
- At the junction of the penis and scrotum
- On or between the scrotal folds
Posterior hypospadias is more likely to be associated with significant curvature and other anatomical differences. These cases often require more complex or staged surgery and careful long-term follow-up.
Causes and Risk Factors
What We Know So Far
The exact cause of hypospadias is not fully understood. Researchers believe it results from a combination of genetic, hormonal, and environmental influences during early fetal development, when the urethra and penis are forming.
Some factors that may increase the likelihood of hypospadias include:
- Family history
Hypospadias can run in families. If a close relative has the condition, the chance may be higher for future sons.
- Maternal factors
Certain maternal conditions or exposures during pregnancy may be associated with a higher risk, such as:
- Advanced maternal age
- Some hormonal treatments
- Possible exposure to certain environmental chemicals
- Associated conditions
Some boys with hypospadias also have undescended testicles or other differences in genital development. These combinations may prompt doctors to look more closely for underlying hormonal or genetic issues.
It is important to emphasize that parents are not to blame. In most cases, there is no clear, preventable cause, and nothing the parents did caused hypospadias to occur.
How Is Hypospadias Diagnosed?
Signs Parents and Doctors Look For
Hypospadias is usually noticed shortly after birth during the newborn physical exam. A doctor may see:
- A urethral opening that is not at the tip of the penis
- A downward curve to the penis
- An unusual shape to the foreskin (often described as a “hooded” foreskin that does not completely cover the underside)
- A urinary stream that sprays, dribbles, or goes in an unexpected direction
Sometimes parents notice unusual spraying or difficulty with urination as the child grows, which leads to evaluation.
If you ever feel unsure about how your baby’s genitals look, it is always appropriate to ask your pediatrician. No concern is too small to bring up when it comes to your child’s health.
Do Children Need Imaging or Tests?
For many boys, a careful physical exam by a pediatric urologist is enough to diagnose hypospadias and plan treatment. In more severe cases, particularly when the opening is very low or when the testicles are not clearly in the scrotum, doctors may recommend:
- Ultrasound of the kidneys or urinary tract
- Blood tests to evaluate hormones
- Genetic tests in rare situations when broader differences in development are suspected
These additional tests help the healthcare team ensure there are no other underlying conditions that need attention.
When to See a Specialist
If your baby has been diagnosed with hypospadias, your pediatrician will usually refer you to a pediatric urologist. This type of specialist focuses on conditions involving the kidneys, bladder, and genitalia in children.
It is sensible to meet with the urologist early, even if surgery is planned for later. This allows time to:
- Understand the specific type of hypospadias your child has
- Discuss treatment options and timing
- Ask questions and prepare emotionally and practically
Treatment Options for Hypospadias
Surgical Repair: What It Involves
The main treatment for hypospadias is surgery. The overarching goals are to:
- Move the urethral opening to a more typical position near the tip
- Straighten any curvature of the penis
- Improve urination and support normal sexual function later in life
- Achieve an appearance that is as natural as possible
Most surgeries are done when the child is between 6 and 18 months old, although the exact timing can vary depending on the child’s health, the severity of the condition, and the surgeon’s recommendation.
Common surgical approaches include:
- Single stage repair
Many mild to moderate cases can be corrected in one operation. The surgeon uses local tissues, often including the foreskin, to create or extend the urethra and reposition the opening.
- Staged repair
In more complex or severe cases, especially with significant curvature or very low openings, the repair might be done in two or more steps. This allows tissues to heal between surgeries and can improve the final outcome.
Hypospadias surgery is usually done under general anesthesia. Children are typically able to go home the same day or after a short hospital stay, depending on the complexity of the procedure and the surgeon’s practice.
What to Expect After Surgery
Recovery can feel intimidating for parents, but your surgical team will walk you through each step.
Key parts of post operative care usually include:
- Pain control
Mild to moderate discomfort is common in the first days. Doctors will prescribe pain relief that is safe for your child’s age.
- Catheter or stent care
In many surgeries, a small tube helps urine drain while the new urethra heals. Parents receive instructions on how to protect it and what is normal to see.
- Hygiene
Gentle cleaning and diaper changes are important to reduce infection risk. You will learn how to keep the area clean without disturbing the repair.
- Monitoring for problems
Call your doctor right away if you notice severe swelling, bleeding, fever, a strong odor, or your child seems unusually distressed.
Follow up visits are essential. The surgeon will check healing, remove any catheter or stitches as needed, and confirm that the child is urinating well.
Long Term Outlook
For most children, the long term outlook after hypospadias repair is very good. Many go on to:
- Urinate standing up with a straight stream
- Have a penis that appears typical
- Experience normal erections and sexual function later in life
That said, some children may need additional procedures or adjustments as they grow. Possible long term issues can include:
- Narrowing of the new urethral channel
- Small fistulas (tiny connections where urine leaks out along the repair)
- Persistent curvature
Regular follow up through childhood and sometimes into adolescence helps catch and address these issues early.
There is also an emotional and psychological side to consider. As boys grow older and become more aware of their bodies, some may have questions or concerns about their history of hypospadias. Having a supportive medical team and open family communication can make a big difference.
Emotional and Psychological Support
For Parents: Coping With Worry and Guilt
It is very common for parents to feel anxious, shocked, or even guilty when they first hear the word “hypospadias.” Many wonder if they somehow caused the condition or missed something during pregnancy. These feelings are understandable but not supported by evidence.
Helpful strategies include:
- Asking your doctors to explain the condition clearly, even more than once
- Bringing another adult to appointments to help listen and take notes
- Reaching out to mental health professionals if worry feels overwhelming
Remember, seeking support is a sign of strength, not weakness.
For Children: Building Healthy Self Esteem
As your child grows, he may or may not remember his surgery, depending on the timing. What he will remember, however, is how his family talks about his body and his health.
You can support your child by:
- Answering questions honestly in age appropriate language
- Emphasizing that bodies come in many variations and that his is not “wrong”
- Encouraging open communication so he feels safe bringing up worries
If your child shows signs of embarrassment, shame, or withdrawal related to his body or genital area, consider speaking with a pediatric psychologist or counselor familiar with medical conditions.
Finding Community: Support Groups and Resources
Connecting with other families who have gone through hypospadias can be incredibly reassuring. Support groups, whether online or in person, offer:
- Real life experiences and practical tips
- A space to share emotions and fears
- Encouragement from parents who are further along in the journey
Your pediatric urologist may be able to recommend reputable organizations or communities. Be selective about online information and always cross check medical advice with your child’s healthcare team.
Working With Schools and Caregivers
In most cases, children with hypospadias do not need special treatment at school. However, there may be times when teachers or caregivers should be aware of the child’s history, such as:
- Shortly after surgery, when physical activity might need to be limited
- If the child has scheduled medical follow ups
- If emotional or social issues crop up around bathroom use or body awareness
You never have to share details beyond what feels appropriate, but open communication with key adults in your child’s life can help ensure he gets the understanding and support he needs.
Moving Forward With Knowledge and Confidence
Hypospadias can feel overwhelming at first, but with accurate information, skilled medical care, and emotional support, most families find their footing. The condition is treatable, and many children who undergo repair grow up with normal function and confidence.
If your child has been diagnosed with hypospadias, you are not alone. Ask questions, lean on your healthcare team, connect with other families, and give yourself permission to feel whatever you feel. Step by step, you can navigate this experience in a way that protects your child’s health, dignity, and future.
