EP236: Seeking clarity on hypospadias and intersex conditions | PUTTING DR G ON THE SPOT
Consultant urologist Dr George Lee Eng Geap, or a.k.a Dr G, enlightens a reader on more a condition called hypospadias as he has experienced problems with the opening on the underside of his penis as well as undescended testicle.
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00:00In the month of August, we've been focusing on various conditions labelled as intersex.
00:07In fact, intersex is actually quite a wide umbrella of conditions that actually has no
00:14definitive definition.
00:16And one condition we're going to talk about today sometimes can be considered intersex
00:21and some experts do not consider this to be intersex and it's a condition called hypospadias.
00:30Hypospadias, as we have discussed in paediatric condition before, is a condition that affects
00:41one in 200 to 300 boys born.
00:48What exactly is it?
00:49In fact, it's a condition characterised by three things.
00:53Number one, the opening of the tip of the penis actually is displaced and it's displaced
01:00downwards.
01:01Number two, as a result of that, the penis will bend downwards.
01:06Number three is that it will create a naturally hooded appearance of the foreskin.
01:13And the three conditions itself actually constitute a condition called hypospadias.
01:20Just 90% of the time, actually it's quite mild and only affects the very, very tip of
01:27the penis being displaced downwards.
01:30So it is not significantly causing any problems.
01:34However, 10% of hypospadias may have some problems generating some ambiguity of the
01:42genitalia.
01:44For example, if the hypospadias is causing opening of the penis to be in the bottom part
01:51of the shaft of the penis, then the penis itself will look shorter and also 10% of this
01:57condition is associated with undescended testicle and it appear to be causing ambiguous genitalia.
02:05In reality, 99.99% of boys born with hypospadias actually is XY gene, so genetically a boy.
02:16However, the actual, the growing part of the development is impeded.
02:24For example, during gestation between the first five to eight weeks, there is a so-called
02:31non-hormonal dependent development of external genitalia.
02:38Between eight to 13 weeks, the male hormone, the testosterone, will influence the elongation
02:45of the penis and the phallus.
02:48If the woman, the mother, is exposed to some female hormone, for example, estrogen, or
02:56the testosterone is not really actively causing the elongation of the penis, then hypospadias occur.
03:05So by definition, that can actually cause nurture resulting the hypospadias.
03:12However, we also know that boys who are twins, who are genetically identical, also has a
03:19higher risk of hypospadias.
03:22And that tells us that there's certain epigenes also influence hypospadias.
03:28On that argument, some people classify boys with hypospadias as a condition that falls
03:36under umbrella of intersex.
03:39The reality is that the corrections of hypospadias is pretty easy.
03:43Effectively, the operation will result in a circumcision, actually advancements of the
03:50tip to the penis, and also straightening of the penis.
03:54For the final week, we're going to talk about gender reassignment or gender reaffirming
04:00operation.
04:01So if you're interested to find out more about gender reassignment operation, stay
04:05tuned for next week's Putting Dr. G on the Spot.