All About The Penis, Men & Male Sexuality

Hypospadias - the hypospadic penis

I work as a psychotherapist with an organization devoted to the emotional support of men with hypospadias, a condition in which the penis does not develop normally before birth.

As a result, the baby boy is born with a penis whose opening appears anywhere from the underside of the glans to the bottom of the penile shaft, perhaps with other less usual features of development such as a twisted shaft, a hooded foreskin, a hooked appearance, and so on. 

The consequences of this not-normal development on the self-image of the man concerned (or the boy concerned) vary enormously. Some guys are totally unfazed by having a different penis, and live lives of complete normality.

The majority, however, are affected in some way by a penis with hypospadias, and even if they marry or have a gay partnership, will continue to seek understanding and explanation of what has happened to them for much of their adult lives - no matter how successful their relationships and the rest of their lives may be. They may also become obsessed by the penis, and, even if they are not gay, continue a search for what represents normality in the penis all their adult lives.

This often involves a desire to look at other guys' penises and see how they compare to their own. This in turn often leads the man with hypospadias to wonder if he is gay. Often the answer is a categorical "no" - his interest in penises is about comparison and trying to understand how he - and his penis - are different.

All of this proves to me how important the penis is to a guy's sense of power and maleness. Unless you have an not-normal penis (I hate the word "abnormal"), I don't think you can begin to understand the subtlety and depth of the ways in which your penis influences your sense of maleness, of being a man.

Some men with hypospadias who also have a small penis tell me that they have had moments of complete insight where they've connected their sense of being incomplete, of being less than a full man, of lacking male power, with the shape and size of their penis.

Is this, I wonder, the product of modern society, where we have learned to associate maleness with penis size and potency? A society where anything that differs from the XY average implies a lack of maleness and masculinity? Or is it something deep inside us, a deep inheritance from generations of male ancestors who came before us, that tells us that our penis is indeed the center of our male form and function?

I've always believed the former, "society made us this way", explanation, but having worked with so many men with hypospadias, I'm now beginning to doubt it. Surely there has to be something fundamental deep inside us, the outcome of many millennia of the expression of male genes, which gives us the subconscious sense of our penis being the essential symbol of our masculinity?

One observation which supports this idea is that a man with hypospadias will often report that his female partner completely fails to understand his obsession with the appearance of his hypospadic penis, and, irritated, will say: "But it doesn't matter to me, so why should it matter to you?" 

The answer, of course, is that a woman cannot understand how significant and meaningful his penis is to a man.

And, understanding how significant this issue is to most men, I think it is fair to say that most men who have it need some degree of therapy. Conventional psychotherapy is great, but you may find that there are few male therapists around who understand it enough to really stand alongside you in the fire as you work through these issues. Another approach is to use emotional freedom technique, also known as EFT or EFT tapping.

So what, then, does one do for a man who has a penis that is not like other men's? First of all, I believe, we must protect boys who are born with hypospadias from the consequence of ignorance and lack of understanding.

Many of these men tell me that they never talked about their penis with anyone - not their father, their doctor, their friends.

Many did not even know that they had an abnormal penis until they began an active sex life, though they often had a sense of being different in some way for many years before that. (I take this to represent a level of profound subconscious understanding in the male psyche of how the masculine form "should" be manifested if all the mechanisms of male development function correctly.) 

In other words - tell a boy with hypospadias that his penis is different! Let him know how, and why, and what it may mean for him - but do it in a way that is appropriate for his age and level of understanding. It's his father's job to do this, no matter how difficult the father may find it. (If the father does not know how to do this, he must find out from people who do.)

Emphasize that the boy is, or will be, as much a man as any of his peers. Ensure that he has the means to defend himself against any consequences of his hypospadias, such as his peers spotting that his pee comes out of the underside of his penis, or observing that he does not develop normally at puberty. What does this mean in practice?

At the very least, it means privacy, the right to keep his body private, the ability to opt out of school sports without having to explain himself. At least in Britain, recent legislation has allowed all children in school the benefit of private changing facilities, but I would argue that any child who does not wish to take part in sports because of self-consciousness about their body should not be forced to do so, especially boys with hypospadias.

And then there is the vexed question of surgical intervention: to operate or not? Many doctors will routinely encourage  parents to opt for surgical correction, on the grounds that the boy needs to see himself as normal.

And I understand this position: I have seen the consequences of not being normal many times. But - and it is a big but - there are a lot of men who were operated on as a child who really resent what was done to them. Often the surgery was not explained to them; sometimes they have ended up undergoing a series of failed  procedures at the hands of incompetent surgeons.

My opinion is this: as a general rule, minor hypospadias almost never needs to be corrected, since a boy will often appear completely normal and his sexual function will also be normal. More severe hypospadias (where the opening of the urethra falls below the coronal rim) should only be corrected if the surgeon is confident of a great result - and highly experienced in the procedure. The worst cases of hypospadias, where the opening of the penis lies near the bottom of the penile shaft, should always be corrected by a surgeon who is experienced in urethral reconstruction.

And what of the men who live as adults with hypospadias? If this is you, the first thing that you need is support: fortunately, that is not hard to get, since there are several great support groups that you can join, full of men who will understand exactly what you have been and are going through. Whether you fear a sexual relationship, or you are living with depression or anxiety or low self-esteem, help is at hand. You may also wish to arrange a meeting with some of the men who have hypospadias, so you can compare how you look in a non-threatening, non-sexual atmosphere. 

The helpful Hypospadias and Epispadias Association is on heainfo.org while a UK support group can be found here. And there's a thesis on the effects of hypospadias at www.hypospadias-emotions.com

If you'd like to email me personally, here's the address:

moreinfo "at" my-penis.org

 

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