Hypospadias is a birth (congenital) defect in which the opening of the urethra is on the underside of the penis. The urethra is the tube that carries urine and semen through the penis and outside the body. In males, the opening of the urethra is normally at the end of the penis.
Hypospadias occurs in about 1 in 200 newborn boys in the United States. The cause is often unknown.
Certain factors may be associated with the condition, such as:
Other factors may also play a role:
Symptoms depend on how severe the problem is.
Most often, boys with this condition have the opening of the urethra near the tip of the penis on the underside.
More severe forms of hypospadias occur when the opening is in the middle or base of the penis. Rarely, the opening is located in or behind the scrotum.
This condition may cause the penis to curve down during an erection. Erections are common in infant boys.
Other symptoms include:
Some boys with hypospadias have one or both testicles that have not moved down into the scrotum (undescended testicle).
This problem is usually diagnosed soon after birth during a physical exam. Imaging tests may be done to look for other congenital defects.
Infants with hypospadias who have one or both testicles that have not moved down into the scrotum may need genetic testing (karyotyping) to check for genetic conditions.
The goals of treatment are:
Infants with hypospadias should not be circumcised. The foreskin should be kept intact for use in later surgical repair.
In most cases, surgery is done before the child starts school. Most urologists recommend repair when the child is between 6 and 12 months and before 18 months old. During the surgery, the penis is straightened and the opening is corrected using tissue grafts from the foreskin. For more complex cases, the repair may require several surgeries.
In some cases, if the hypospadias is very mild and there is no curve in the penis, surgery may be optional. However, even very mild cases may need to be repaired to prevent possible future problems. It's important to discuss the benefits and risks of treatment with your health care provider when deciding what is best for your child.
Results after surgery are most often good. In some cases, more surgery is needed to correct:
Most males can have normal adult sexual activity.
Contact your provider if your son has:
Chan Y-M, Hannema SE, Achermann JC, Hughes IA. Disorders of sex development. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 24.
Di Carlo HN, Crigger CB. Anomalies of the penis and urethra. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 581.
Long CJ, Zaontz MR, Canning DA. Hypospadias. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 45.
BACK TO TOPReview Date: 3/31/2024
Reviewed By: Sovrin M. Shah, MD, Associate Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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06/01/2025
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