What are the emotional consequences?

Boys and men with hypospadias develop a variety of emotional responses related to the condition. For the vast majority of men affected, the experience of hypospadias is generally kept as an intimate “secret”. This secrecy occurs firstly because penis size and shape are subjects rarely approached sensibly in our society, and secondly because hypospadias is a birth difference barely discussed in the press or other media. This means that men affected by hypospadias have very little access to basic information which might be useful for them – for example, most are not aware that is a relatively common condition.

Obviously a penis with hypospadias differs from what is generally thought of as “the norm”, though even normal penises have a wide variety of shapes and sizes! That said, a boy or man with hypospadias will feel different or even abnormal when he compares himself with other boys or men, or when he compares his penis with a “normal“ penis. What makes this worse is not understanding what hypospadias actually is, and being unable to discover anything about it. The outcome is that many young boys, adolescents, and adult men grow up with no understanding of why the most important physical feature of their maleness – their penis - is “different”. As boys, they begin to compare themselves with other boys and discover that they are “different” and therefore perhaps “deformed”, or somehow less of a man. If these quite understandable feelings are not discussed with them as young boys, they may grow up with feelings of inadequacy and/or have a negative body image.

They may begin to avoid situations that are part of everyday life, such as using a public urinal. They may avoid sexual intimacy with another person, and this can produce a negative emotional cascade. And so a boy or man with hypospadias may feel that he will never be able to perform as well as other men do. This feeling of being “different” and “inferior” can generate a range of negative emotions such as depression, anxiety, insecurity, frustration, anger, confusion, humiliation, shame and powerlessness. With time, the experience of these negative emotions can profoundly impair the psychological, social and sexual functioning of the young boy and the man he becomes. Furthermore, it may significantly impair his academic and professional achievement. Some boys or men are so distressed that they do not see solutions to this problem and become prone to depression and suicidal thoughts. Some have been driven to self-harming themselves.

Not all boys and men with hypospadias have these kinds of emotional experiences. Either because they grew up in a supportive family or because they benefited from the presence of a supportive friend or partner, some men with hypospadias have never faced such emotional challenges, or they have managed to resolve them. Indeed, many boys and men with hypospadias adapt very well to their "difference". Their positive acceptance of themselves means that hypospadias does not affect or control their lives, and they experience happiness and pleasure in all areas.