Opening in the wrong place on the penis

Normally, the opening of the urethra (the tube for urine and semen) is at the end of the penis, in the middle of its head (glans). About 1 in every 300 males is born with the opening on the underside, and the middle of the glans just has a blind dimple. This is called hypospadias. It tends to run in families; if one child has hypospadias, his brothers have a 1 in 20 chance of also having it.

In 65% of men with hypospadias, the opening is on the underside of the head of the penis, near where it joins the shaft, but it can be anywhere along the underside of the shaft or even at the root of the penis near the testicles. If the opening is on the shaft, the end of the penis may bend when it is erect; this does not occur if the opening is near the head. The foreskin is often abnormal as well; part of it is missing on the underside of the penis, so it looks like a hood.

Effects of hypospadias
Hypospadias does not make you incontinent because the urine flow is controlled by the neck of the bladder, which is higher up inside the body. However, it can make it difficult to direct the stream of urine accurately, and some men with this condition choose to sit down when they pass urine.

Treatment
Severe hypospadias, where the opening is on the shaft or near the testicles, will have been noticed at birth, and will have been put right by an operation at the age of 12–18 months. Babies with slight hypospadias, where the opening is on the head of the penis, not far from the dimple, do not always have an operation. If you have hypospadias that was not operated on, but which bothers you because of the appearance of the foreskin or because you cannot control the direction of the urine stream, ask your family doctor to refer you to a urological surgeon who will be able to give you more information and discuss the options. Seeing a surgeon does not commit you to having an operation.