Hypospadias is a congenital condition where the opening of the urethra — the tube that carries urine out of the body — is located on the underside of the penis rather than at the tip. It is one of the more common birth differences seen in male newborns. The good news is that hypospadias is very treatable. With surgery, most boys grow up to have completely normal urinary and sexual function.
What Is Hypospadias?
In a typical male anatomy, the urethral opening sits at the very tip of the penis. In hypospadias, that opening forms somewhere along the underside instead. This happens during fetal development, when a hormonal irregularity causes the urethra to form incompletely.
Hypospadias varies in severity. In most cases, the opening is near the tip of the glans, which is considered a mild form. However, in less common cases, it may appear along the middle of the shaft or even near the base of the penis. In rare cases, the opening can be located at or below the scrotum.
According to Mayo Clinic’s overview of hypospadias, this condition affects roughly 1 in every 200 male births, making it one of the most frequently seen urological birth conditions worldwide.
Recognising the Signs and Symptoms of Hypospadias
Most cases of hypospadias are identified by a doctor or midwife shortly after birth during the routine newborn examination. In milder cases, however, the condition may be less obvious at first glance.
Parents should look for the following signs:
The urethral opening is not at the tip of the penis
The penis curves downward (called a chordee)
The foreskin only covers the top side of the penis, leaving the underside bare
An unusual or downward spray when urinating
These signs can vary depending on how far along the underside the urethral opening is located. Even mild cases deserve medical attention, as treatment is most effective when started early.
What Causes Hypospadias?
Hypospadias develops during pregnancy, typically between weeks 8 and 14. During this time, hormones guide the normal formation of the urethra and foreskin. If those hormonal signals are disrupted or incomplete, hypospadias can result.
In most cases, there is no single clear cause. However, researchers have identified several factors that may play a role.
Genetic Factors
Hypospadias can run in families. If a father or brother has had the condition, a male child has a higher chance of being born with it as well. That said, many boys with hypospadias have no family history of it at all.
Hormonal and Environmental Influences
Exposure to certain hormones during pregnancy may increase the risk. For example, progesterone or synthetic progestins — sometimes used during in vitro fertilisation (IVF) — have been associated with a slightly higher rate of hypospadias. Advanced maternal age at the time of conception may also be a contributing factor.
Healthline’s guide on hypospadias causes and risk factors provides a helpful summary of current research in this area.
Risk Factors for Hypospadias
Certain factors may increase the likelihood of a baby being born with hypospadias. These include:
Family history: A father or sibling with hypospadias raises the risk
IVF conception: Exposure to hormones used during fertility treatments may play a role
Older maternal age: Mothers over 35 may have a slightly higher risk of having a child with this condition
It is important to remember that having one or more of these risk factors does not mean a child will definitely be born with hypospadias. Many cases occur with no known risk factors at all.
When to See a Doctor
Most cases of hypospadias are caught right away in the hospital by the care team in the maternity ward. However, milder forms can sometimes go unnoticed in the early days after birth.
You should speak with your family doctor or visit a walk-in clinic if you notice any of the following after taking your baby home:
The urethral opening does not appear to be at the tip of the penis
The foreskin looks incomplete or only covers the top
The penis appears to curve downward
Your child has an unusual urine stream as they grow older
Your family doctor can assess the situation and refer you to a paediatric urologist — a specialist in urinary conditions in children — if needed. In Canada, referrals to specialists are typically managed through your provincial health plan. If you do not have a family doctor, a walk-in clinic can help start that process.
Do not delay seeking care. Early diagnosis leads to better outcomes, and surgery is most successful when performed in the first year of life.
Diagnosing Hypospadias
Diagnosing hypospadias is straightforward. A doctor can usually confirm the condition through a simple physical examination. No blood tests or imaging are typically required for a standard diagnosis.
In more complex cases — for example, when the opening is located near the scrotum — additional testing may be needed to rule out other conditions related to sexual development. A paediatric urologist will guide this process.
How Is Hypospadias Treated?
Surgery is the standard treatment for hypospadias. The goal is to reposition the urethral opening to the tip of the penis and, if needed, to straighten any downward curve of the penis.
What Happens During Surgery?
During the procedure, the paediatric urologist uses tissue — often from the foreskin or, in some cases, from inside the mouth — to reconstruct the urethra. The surgery is performed under general anaesthesia, so the child feels no pain during the procedure.
Most operations take between one and a half to three hours. In complex cases, more than one surgery may be required to achieve the best result.
When Should Surgery Be Done?
Surgeons generally recommend operating between 3 and 18 months of age. Operating during infancy has several advantages. Healing is faster, anaesthesia risks are lower for short procedures, and the child has no memory of the experience.
One important note for parents: do not have your son circumcised before hypospadias surgery. The foreskin tissue is often used by the surgeon to rebuild the urethra. Removing it beforehand can make the repair more difficult.
Possible Complications
Most hypospadias surgeries are successful, with no lasting complications. In a smaller number of cases, a fistula may develop. A fistula is an abnormal opening on the underside of the penis where urine can leak. If this happens, a follow-up surgical procedure can correct it.
Furthermore, leaving hypospadias untreated can cause problems later in life. These include difficulty toilet training in early childhood and challenges with sexual intercourse in adulthood. Therefore, timely surgical treatment is strongly recommended.
For more detailed information on surgical outcomes, Health Canada’s health information resources can help connect you with provincial programmes and paediatric care centres near you.
Living With Hypospadias: What Parents Should Know
Hearing that your newborn has hypospadias can feel overwhelming. However, this is a well-understood condition with a strong track record of successful treatment.
Most boys who receive timely surgical care go on to have completely normal urinary function and sexual health as adults. Regular follow-up appointments with a paediatric urologist will help monitor your child’s recovery and development.
As a parent, it also helps to avoid circumcision until you have spoken with a specialist, and to keep all follow-up appointments after surgery. Ask your paediatric urologist about what to expect during recovery, including any temporary use of a urinary catheter after the procedure.
Always speak with a qualified medical professional — your family doctor or a paediatric urologist — before making any decisions about your child’s care. Every child’s situation is unique.
Frequently Asked Questions About Hypospadias
Is hypospadias a serious condition?
Hypospadias is a common congenital condition, but it is not life-threatening. With surgical treatment, most boys with hypospadias develop completely normal urinary and sexual function. Early diagnosis and timely surgery lead to the best outcomes.
Can hypospadias correct itself without surgery?
No, hypospadias does not correct itself on its own. Surgery is required to reposition the urethral opening and, if necessary, straighten the penis. Without treatment, the condition can cause difficulties with urination and, later in life, with sexual function.
At what age is hypospadias surgery performed in Canada?
Paediatric urologists generally recommend performing hypospadias surgery between 3 and 18 months of age. Operating during infancy allows for faster healing and better surgical results. Your child’s specialist will recommend the best timing based on the severity of the condition.
Is hypospadias covered by provincial health plans in Canada?
In most provinces and territories, medically necessary surgery for hypospadias is covered under provincial health insurance plans. You should speak with your family doctor or paediatric urologist for a referral, which is typically required to access specialist care under your provincial plan.
Does hypospadias affect fertility?
Hypospadias itself does not directly affect fertility. However, if left untreated, the condition may make sexual intercourse more difficult, which could indirectly affect the ability to conceive naturally. Surgical correction typically resolves this concern.
Should my son be circumcised if he has hypospadias?
No. If your son has hypospadias, circumcision should not be performed before surgical repair. The foreskin tissue is often used by the surgeon to reconstruct the urethra during hypospadias surgery. Removing it beforehand can significantly limit the options available to the surgical team.
Key Takeaways
Hypospadias is a congenital condition where the urethral opening forms on the underside of the penis rather than at the tip
It is one of the most common urological birth conditions in male newborns
Severity varies — from mild cases near the tip to more complex cases near the base or scrotum
The exact cause is often unknown, but genetics and hormonal exposure during pregnancy can play a role
Surgery is the standard treatment and is most effective when performed between 3 and 18 months of age
Do not have your son circumcised before hypospadias repair, as foreskin tissue may be needed for reconstruction
Most boys go on to have completely normal urinary and sexual health after successful surgery
If you have concerns, speak with your family doctor, visit a walk-in clinic, or ask for a referral to a paediatric urologist through your provincial health plan
This article is for general informational purposes only and does not replace professional medical advice. Always consult your family doctor or a qualified healthcare provider regarding your child’s health and treatment options.
