Your baby boy has been born and the first thing you do is lovingly go over every inch of him. You count fingers and toes and look at the adorable ears. You ask the delivery team if everything is normal but sometimes not everything is.
Although it can be horrible to find out that your baby has a misshapen hand or foot, but what if you find that your baby has an abnormality of the genitals?
There are several types of genital malformations that can occur in a baby boy. These include problems with the location of the urethra, which is the opening that should be at the tip of the penis. Other problems can include issues with the shape or size of the penis or with one or both testicles not having descended into the scrotum. This blog has covered undescended testicles here and here. This post will cover deformations or defects of the penis.
There can be several possible causes of genital malformations because the development of a baby’s body in the uterus is complex. Genes, hormones, and environmental factors can play a role in why a malformation has occurred, but sometimes the cause is never known. In a baby boy, certain male hormones called androgens (which includes testosterone) must be present in the right amount for the penis to develop correctly. If the right amount of androgens are not present or if the baby does not react correctly to those hormones, the genitals may not develop correctly.
Micropenis may be caused by too little androgen during fetal development. A mother’s age and weight may be factors in other types of genital malformations. Mothers who are above age 35 and are obese are more likely to have a baby boy with a malformation of the urethra.
If your child has a malformation of his penis, he may need to be seen by specialists, such as pediatric urologists or endocrinologists. A pediatric urologist is a specialist who focuses on problems with the urinary tract and the male genitals. A pediatric endocrinologist who focuses on problems with hormone levels in children.
In some babies, malformations of the genitals are accompanied by other birth defects. Your baby will need a complete physical examination to check for other problems. This examination will include blood tests to check for hormone levels.
The urethra is the tube that carries urine and sperm out of the body and the end of it is normally located at the tip of the penis. If the urethra is not located at the tip of the penis, it is a relatively rare condition called hypospadias which happens in about 1 in every 200 babies. Hypospadias is diagnosed by a healthcare professional during a physical exam of the baby.
The degree of hypospadias can vary, with the opening of the urethra located very near the tip of the penis (called a subcoronal hypospadias), where the penis and scrotum meet (a penoscrotal hypospadias), or anywhere along the shaft of the penis (a midshaft hypospadias).
A hypospadias can cause the penis to curve. The curve along with the location of the urethra can cause problems later with urination because the urine stream may spray. A boy with hypospadias might need to sit while urinating. Hypospadias can accompany an undescended testicle.
For most cases of hypospadias, the baby will need to have surgery to correct the problem. Usually, this surgery is performed between the ages of 3 and 18 months. Correcting a hypospadias may take two or three surgeries and the surgeon may need to use the baby’s foreskin to make the correction. Because of this, a baby with hypospadias should not be circumcised before the corrective surgery.
Another abnormality of the urethra is epispadias, which can occur in about one in 117,000 boys. In this condition, the urethra has not developed completely and the opening to the bladder may be in the lower abdomen. Epispadias can occur in girls as well as boys, although it is rarer in girls, occurring in about one in 484,000 baby girls. It can be accompanied by other defects, such as defects of the pelvic bone or bladder.
Some baby boys are born with a penis that is smaller than normal, a condition called micropenis. Normally, a normal newborn boy’s penis can be from 1.1 to 1.6 inches long, measured from the tip to the base. This measurement is made while gently stretching the penis. The circumference of a baby’s penis is normally between 0.35 and 0.5 inches around. A baby’s penis that is shorter than 0.75 inches is considered to be a micropenis.
Micropenis is diagnosed by physically examining the baby and measuring the length of the penis. Sometimes, with a baby who is chubby, the fat around his abdomen may cause his penis to look like it is too small, but it is actually within the normal range.
Treatment for micropenis may include treating the baby with hormones that can help stimulate the growth of the penis. In some cases, especially if there is also hypospadias, surgery may be used to correct the problem. There are risks and benefits to either type of treatment. Hormone therapy can affect your baby’s growth while surgery carries the risk of infection.
If you are concerned about your baby’s genitals, talk to your pediatrician.