Psychosexual development of children and adolescents with hypospadias

Introduction. Hypospadias is the most common malformation of the penis. Despite the common assumption that hypospadias may affect children's psychosexual development, only a few studies report on the patients' psychosexual adjustment during childhood and adolescence. Aim. A comprehensive, cross-sectional investigation of the psychosexual development of boys operated on for hypospadias in comparison to a healthy control group. Methods. Sixty-eight children and adolescents (7-17 years) operated on for hypospadias were examined by means of a standardized interview assessing penile self-perception, gender-role behavior, sexual experiences, and sexual attitude. Scores were compared to an age-matched control group consisting of 68 boys after hernia repair. Predictive values of medical variables as well as the patients' knowledge of hypospadias were assessed. Main Outcome Measures. The Pediatric Penile Perception Score, the Gender-Role Questionnaire by Ijntema and Cohen-Kettenis, and a self-developed questionnaire on first sexual experiences and sexual attitude comprised the standardized assessment instruments. Results. Boys with hypospadias did not significantly differ from the control subjects with regard to penile self-perception, gender-role behavior, first sexual experiences, and sexual attitude. Younger age and the patient's knowledge of hypospadias predicted a more positive penile self-perception, while a more pronounced masculine gender-role behavior was best predicted by younger age at final surgery. Conclusions. Boys with corrected hypospadias may show a psychosexual development that is similar to healthy children. Puberty could be a critical time for the patients, however, during which they might require regular urological follow-ups and may benefit from age-appropriate information about their penile condition. Moreover, the later corrective surgery is completed, the more likely the patients may become insecure with regard to gender-role behavior.