The Lost Hole

Dear Dr. G,

I am a 30-year-old man and have been married for two years. My wife and I have a normal sex life and she is reasonably satisfied, I think.

We were thinking of having baby and went for a check up. My sperm count is fine, but the doctor said I have a “structural problem” that could render me infertile.

The doctor observed that there is no opening at the tip of my penis and the actual opening is at the bottom part of my manhood. He said this condition is called hypospadias, where the opening of my penis somehow got “lost” during the gestation period.

My penis has always pointed downwards when erect and the foreskin looks odd and is “hoody shaped”. I don’t really take much notice of this nor the fact that the opening is hidden at the bottom part of my manhood!

Don’t get me wrong, I can still have penetrative sex and masturbate. However, the downside is exactly that – when urinating, it sprays downwards and inwards towards my trousers, and similarly with my ejaculate.

The doctor has assured me that I do not need an operation if this does not affect my performance between the sheets. However, I am getting self-conscious about my “lost hole” and would like to put Dr G on the spot.

What exactly is hypospadias? How does the hole get lost during gestation?

Will this affect my sex life and is there any corrective surgery to put things back where they should be? Will the operation make me more fertile and better in bed?

Regards,
The Lost Soul

Hypospadias is a congenital disorder characterised by a urinary opening that is not located at the tip of the penis. Instead, it can be located at the lower part of the glans, penile shaft, or even at the base of the penis near the scrotum.

Hypospadias is the second most common birth abnormality of the male reproductive tract (after undescended testicles) and affects one in 250 males.

The etiology of hypospadias is believed to relate to defective development of the penis during gestation. In a normal embryological development, the formation of the penis requires the protrusion of penile structure, surrounded by a urethral plate, extending the channel opening to the tip of the penis.

In the case of hypospadias, the extension to the tip is prematurely interrupted, causing incomplete tabularisation. The exact reason of this “developmental arrest”, however, is unknown. As a result of this defect, the boy will be born with a hole on the underside of the penis instead of the usual location at the tip.

Presentations of hypospadias have distinct characteristics. This often results in a foreskin that does not “wrap” around the glans completely and also gives the foreskin a “hooded” appearance as it does not cover the underside of the glans.

It may also cause a downward bending of the penis, which is referred to as chordee.

The literature reveals that there is a higher incidence of erectile dysfunction in men with hypospadias, especially those with severe chordee. The vast majority of hypospadias sufferers only have a slight downward-pointing opening, and their propulsion of ejaculate may not be “charging ahead”. However, this slightly skewed discharge of semen usually does not render the sufferer infertile.

Reconstructive surgery to correct the triad of malformations (the lost opening, hooded foreskin and downward bend) is possible, with the majority of such operations done on infants from the age of three months. Adults are rarely operated on as most sufferers have mild hypospadias that have no impact on their urinary and sexual functions. However, men who face the embarrassment of urinary spraying or the peculiarity of their manhood may benefit from the operation.

As most instances of hypospadias are minor, the imperfection is mostly a variation of the norm which does not affect procreation or recreation.

The American poet and philosopher, Henry David Thoreau once said: “Not until we are lost, do we begin to understand ourselves”.

When Dr G is put on the spot by the lost souls with the “lost hole” his response is; “when we begin to understand ourselves, then we realise we are not that lost anymore!”