Feeling conflicted about hypospadias repair

[dickybird]

OK, this isn't strictly a circumcision question, but since this seems to be the forum for the discussion of all things related to the foreskin, I thought I'd put it here.

My 7 m.o. DS was born with a fairly mild case of hypospadias (the urethral opening is on the underside of the glans). His penis also has a slight downward curve to it. We brought him to a urologist for an assessment, and he said as long as he can pee forwards (as opposed to downwards), then he'll be able to stand to pee, and probably won't have fertility issues when he's older. He wouldn't make a recommendation whether to do the surgery or not, since he's not a specialist and wouldn't be doing the procedure anyways. If we wanted to pursue it further, we'd have to drive 6 hours to see a pediatric urologist.

DH and I came away from the appointment feeling like we'd rather just leave it alone and let him decide when he's older if he wants it repaired. Since then, I've been going back and forth on the wisdom of this decision. Based on what the urologist told us, it seems to be a cosmetic issue. I don't see the point of going through the risks and pain of surgery, not to mention the hassle of having to make the trip out of town to have it done, if it more or less works fine.

On the other hand, I keep picturing how emotionally damaging it could be to a boy if it got around that he has a "deformed" penis. I was teased a lot as a pre-teen and teenager for a variety of things related to my appearance, and it's taken me a long time to get over it. Maybe lame and overly sensitive, but that's where I'm coming from.

But then again, it seems like the teasing issue is the reason why RIC is so prevalent in the US, and I think that argument is bunk. I'm very anti-circ, and I have to admit that it bothers me immensely that in order to repair the hypospadias, he would be circed. In addition to my belief that RIC is just wrong, DH is not circed, nor are any of the men in his family, and we live in an area with low circ rates. I don't know of any of my friends with little boys who had them circed. So, I guess it would be kind of embarrassing to me if someone noticed that he was circed and assumed that I was "that" sort of parent. Again, this is my hang-up, and I realize that.

I'm not really sure what my question is exactly, but I'd love some of your thoughts while I sift through this. Thanks!

[tennisdude23]

I would wait because of one reason, medical advances. I know little about hypospadia, but I do realize that the traditional approach is to use the foreskin to repair the damage. However, recently, doctors have began using other tissue, mostly from the mouth, to repair hypospadia. I am assuming that this approach usually involves a highly competent specialist, not just a regular ped. urologist. Interestingly, the question now remains what will be done 10 years from now? Maybe other, less invasive techniques will be developed, which is why I say it might be a good idea to wait, given that your son that does not have real problems from his hypospadia. It seems to be only a question of cosmetics. Well, in that case, I think that it should be up to your son to decide what he wants to do in that regard. When it comes to teasing, really, I don't think anybody will be checking the position of your son's urethra. First of all, it's would hard to notice I think a deformity from just quick glances and secondly, guys for the most part stick to their own business in the locker room. So, I think social pressure is just not valid in this case or for RIC. So, if it's not causing problems, I would wait and see. If you son likes the way he is and will continue to do so, then this issue will go away and he will still keep all his foreskin. If not, then he can have whatever surgery is deemed necessary. I think in that regard everyone wins; and you don't have to worry that a premature decision may have been the wrong one.

I am curious what state do you live in with the low RIC rates?

[perspective]

Its perfectly understandable that you feel conflicted, the surgery was done on myself when I was a baby, and I still would not know exactly what I would do if I could go back in time and have control over the situation.

One thing I have realized is this: All the concerns about "fixing" his penis, does not come from any problem he has, but from how the doctors, and parents think he will feel because his penis is "different". The idea behind this surgery is to "give him back" a 'natural' penis. Yet thats a penis he never had. He already has a natural penis, its just different then whats natural for most.

I have had a lot of time to think about this question. For most of us, a normal penis is obvious, its the one that most boys are naturally born with. But for your son, and for me, our NATURAL penis is something different then that. The prevailing belief in the medical community, is to be happy and healthy a boy needs to have a "normal" penis.

But the new mainstream belief of the mental health community is that boys and men tend to be happier with their body when they are able to keep their natural one. Here is a link to a thread from this board that mentions a study that talked to men with un"repaired" hypo's and found they were perfectly happy with it. http://www.mothering.com/discussions...d.php?t=890672

Its hard enough to figure out what we want, let along what is best for someone else. There is nothing wrong with your son, the state he is in, is that state nature made him, and he could be quite happy being like that for the rest of his life. If he ever wants to change that, he can.

When it comes to hypo surgery, there is a lot of gray areas, but please dont worry. Also, when your son walks around naked (locker rooms and such) no one will be able to get a good view of the underside of his penis where the hypo is anyway.

No matter what you decide to do, remember the key point is making him feel confident with his body, and not try to hide or ignore the fact he has/had a different looking penis.

[~Megan~]

I don't know that anyone will see his penis unless he wants them to see it. As I understand it very few schools require showering after gym anymore.

I think like anything else something this minor can be dealt with. If he does eventually want surgery I think its better to do it on an older child with some understanding of what is happening. Also a larger penis is easier to work on. Who knows exactly how his penis will change and grow during puberty. It would be better to do the surgery then, IMO.

[foreskin friendly]

Aside from deciding to leave this decision up to your son..
I also hope that you take the proactive stance of instilling as much self-confidence/esteem as possible.
Any future teasing should easily roll off.
We've all been teased for one reason or another. How we handle it emotionally is what has lasting effects.

Good luck to your family. I would personally leave it alone if their is no medical indication for surgery...
Really, how many people will be seeing his penis for now?

[Quirky]

I'd wait, too, for all the reasons above.

And besides which, standing to pee is not a crucial life function. In fact, I've trained my ds (and my dh too) to sit to pee at home -- it's way, way less messy, and I see no reason guys should stand to pee at a toilet! A urinal is a different thing, it's made for standing to pee, but standing at a toilet is guaranteed to cause some pee splashing and that's just icky.

[hanno]

We chose to do nothing. He's only 13 months but he seems to think his penis is the 2nd greatest thing on earth (first is boobs).

[perspective]

Originally Posted by Quirky

I'd wait, too, for all the reasons above.

And besides which, standing to pee is not a crucial life function. In fact, I've trained my ds (and my dh too) to sit to pee at home -- it's way, way less messy, and I see no reason guys should stand to pee at a toilet! A urinal is a different thing, it's made for standing to pee, but standing at a toilet is guaranteed to cause some pee splashing and that's just icky.

Uncool. (just kidding) It just seems wrong to "train" the males in your house to pee sitting down lol.

Peeing standing up can be important to guys, it may not seem that way to woman, but for male culture it is. Little boys pee together because its fun for them, and sometimes when your a little older, the guy you can pee next to, but still talk to is a close friend. But in a way this is good training for males, because its almost required in our culture to pee standing up, and understand there is a good chance random strangers will see your penis from time to time.

So that is another reason why its not easy to make a choice with this operation. But you have to weigh things out. This boy will still be able to pee standing, even without the operation. Its also been seen (by the study I linked) that in not all, but in many cases men find a natural penis as being more important and linked to their overall happiness then "pee culture".

[MommaLauraRN]

Originally Posted by Quirky

I'd wait, too, for all the reasons above.

And besides which, standing to pee is not a crucial life function. In fact, I've trained my ds (and my dh too) to sit to pee at home -- it's way, way less messy, and I see no reason guys should stand to pee at a toilet! A urinal is a different thing, it's made for standing to pee, but standing at a toilet is guaranteed to cause some pee splashing and that's just icky.

I did the same thing with my DH!!! He's 6 and half feet tall for crying out loud...the splash zone would just be too gross. DS stands for now...but when he gets taller...

[darien]

My ds (now 11) has the same degree of hypospadias, and we also agreed to let him decide if he wants it "fixed." He has no problem peeing standing up.

Honestly, especially with an intact boy, wouldn't you have to get reaallly close to note the location of his pee hole?

[hanno]

More hypospadias things.
From the 3rd image here, how would you know the baby isn't intersex?

My son's looks like the first image here. The 'seam' down the shaft twists slightly. Is that related? normal?

[paquerette]

Originally Posted by perspective

Uncool. (just kidding) It just seems wrong to "train" the males in your house to pee sitting down lol.

I guess the other option is training them to clean the bathroom after they pee. every. single. time.

I don't really buy the peeing culture thing. Maybe among some groups of guys in some places, but I cannot imagine that stockbrokers and accountants and rocket surgeons engage in this kind of behavior.

[DocsNemesis]

I tried to teach my son to clean up after himself, but I got tired of finding pee on the toilet seat, the floor, the tub (ewww)...so he has no choice but to sit now. My dh stands though and makes no mess, even with the toilet seat down .

I have to agree, that 3rd pic looks more like transgender than regular hypospadias. I'd hope they do a DNA test to verify that babe is really genetically a boy before they make him look like one...

[Nathan1097]

I think you mean he's intersexed, not transgendered. And yes, there's a fine line between the sexes when development doesn't go exactly as planned, as they both are identical until 8 weeks gestation.

[BamaDude]

Originally Posted by paquerette

I don't really buy the peeing culture thing. Maybe among some groups of guys in some places, but I cannot imagine that stockbrokers and accountants and rocket surgeons engage in this kind of behavior.

Trust me, they do.

[perspective]

Originally Posted by paquerette

I don't really buy the peeing culture thing. Maybe among some groups of guys in some places, but I cannot imagine that stockbrokers and accountants and rocket surgeons engage in this kind of behavior.

Guys pee standing, if they are friends they may talk at urinals, and it can be a "bonding" type experience, or at the very least something friends that are close do not mind doing.

Its weird, but when men enter the public restroom, rules change. From CEO's to teenage interns, there is this feeling that everybody is on the same level.

(You cant really have any social guards up, when your standing there with your penis out, peeing!)

[dickybird]

Thank you all so much for your input! It's very helpful. You've all affirmed for me that my first decision to leave it alone is the best course of action. My DS is perfect and beautiful just the way he is.

The discussion about peeing standing up is really funny to me. This was my DH's rationale: "can he pee standing up? Yes? what's the problem then?" He remembers it being a real bonding activity to pee on things with his friends. I have to admit, it looks practical to be able to pee standing up when we're backpacking!

tennisdude - we live on the north coast of CA. Not sure about regional RIC rates, but in our community it's quite low. Although the last time we were at the ped's office, there was a mom there with her teeny tiny preemie that had just come home from the NICU, and she brought him in to be circed. As if after being born 5 weeks early, having RSD and spending a month in the NICU, the most urgent problem when he finally came home was the fact that he still had his foreskin. Sorry, way off topic, it just made me so mad! I have to admit that my opinion of our ped (who has been wonderful otherwise) dropped quite a bit upon learning that he would agree to do that to this poor little boy.

[SammyJr]

Another male perspective. I agree with all the voices that say to leave it alone. If the surgery is only cosmetic, then it can wait until your son can have a voice in the matter. Also, I thought that it was possible to repair hypospadius without circumcision, but the procedure was rare in this country because "everyone" wants their son cut.

As for the peeing culture thing, I've never seen it personally. The only rule I know about is the one that says, "Always attempt to leave one stall space between you and the next person." For example, if there's 3 urinals, one should always pick one of the outer urinals and only take the middle one if the others are unavailable.

[Frankly Speaking]

I'll add another voice of agreement to just leaving it alone. This is a very minor case. It appears there are a high level of complications and unexpected outcomes that go along with this repair surgery from reading at hypospadias discussion groups. By and large, the men who had minor degrees of hypospadias and were not repaired were completely satisfied with the form of their penises and had no inclination to have the repair done.

On the "pee culture" thing, I remember back in my college fraternity days, my frat had a country party building. It was two large rooms with one being a bar room and the other being a dance room. There were no restrooms and everyone just went into the woods behind the building. Often the guys would end up going in groups or being in groups once they got there. Instead of going 50' apart, they would invariably end up standing virtually shoulder to shoulder at most 5' apart discussing some other guy's hot date or something. LOL! Guys just grow up to accept this as the normal way to do things.



Frank