What should I consider before my son's surgery?
June 24, 2007 3:27 PM Subscribe
I'm looking for thoughtful advice/opinions on whether to have an elective surgical procedure performed on my son.
(My apologies in advance for the length of this post.)
My otherwise perfect son, now nearly 8 months old, was diagnosed at birth with hypospadias, which is basically a defect of the urethra which results in the urinary opening being in the wrong place. My son has a mild case of this condition, which means his opening is slightly below the normal location, slightly on the underside of the head of his penis. As a result, his foreskin has kind of a "winged" or shawl-like appearance rather than looking like a "turtleneck."
Our pediatrician urged us to see a pediatric urologist, which we did, and we've scheduled the surgery for mid-July. My son goes for his preoperative consultation tomorrow. My understanding is that the surgery involves opening the skin of the penis, using some of the foreskin to redirect/reconstruct the urethra, then inserting a tube that will stay in place for a week or two. Once healing is complete, our son should have a normal appearance.
My husband and I are now having second thoughts about the procedure. Part of the concern is the risk of surgery (I've been told there is about a 3-4% risk of complications, aside from any automatic complications from anesthesia, and most problems should be correctable with a second procedure). I'm dreading the pain my son will endure during recovery, though the accounts I've read online have varied widely as far as how difficult recovery actually is. I'm also concerned about the possibility, however unlikely, that my son might end up with scar tissue that could affect his sexual functioning.
If he doesn't have the surgery, his hypospadias is so mild that he should be able to urinate normally (though he might have to sit) and enjoy normal sexual functioning. However, there is the issue of his penis looking somewhat unusual (the differently-formed foreskin moreso than the placement of the urinary opening), which could be difficult for him both with future sexual partners and if anyone in a locker room, etc happens to notice. My husband especially feels that young people have enough stacked against them in the insecurity department without adding embarrassment about one's genitals. He also thinks that if the surgery is done now, the healing will go more quickly than it would if it were performed later in our son's life (confirmed by the urologist) and our son won't remember, which will minimize the chance of any kind of emotional trauma and/or sexual hangups.
I realize this situation doesn't have a cut-and-dried answer, but I guess I just respect many of the members of this community and was interested in your thoughts on whether a procedure of this sort, that basically qualifies as cosmetic surgery), is warranted. If you've faced a similar situation, either as a parent or a child, I'd especially appreciate hearing from you. I've read so many things -- from descriptions of people who were relieved to be "normalized" by the surgery, to intersex websites that suggest hypospadias repair is traumatic and a form of mutilation -- and I'd like to more thoroughly consider all sides. Thank you in advance.
(My apologies in advance for the length of this post.)
My otherwise perfect son, now nearly 8 months old, was diagnosed at birth with hypospadias, which is basically a defect of the urethra which results in the urinary opening being in the wrong place. My son has a mild case of this condition, which means his opening is slightly below the normal location, slightly on the underside of the head of his penis. As a result, his foreskin has kind of a "winged" or shawl-like appearance rather than looking like a "turtleneck."
Our pediatrician urged us to see a pediatric urologist, which we did, and we've scheduled the surgery for mid-July. My son goes for his preoperative consultation tomorrow. My understanding is that the surgery involves opening the skin of the penis, using some of the foreskin to redirect/reconstruct the urethra, then inserting a tube that will stay in place for a week or two. Once healing is complete, our son should have a normal appearance.
My husband and I are now having second thoughts about the procedure. Part of the concern is the risk of surgery (I've been told there is about a 3-4% risk of complications, aside from any automatic complications from anesthesia, and most problems should be correctable with a second procedure). I'm dreading the pain my son will endure during recovery, though the accounts I've read online have varied widely as far as how difficult recovery actually is. I'm also concerned about the possibility, however unlikely, that my son might end up with scar tissue that could affect his sexual functioning.
If he doesn't have the surgery, his hypospadias is so mild that he should be able to urinate normally (though he might have to sit) and enjoy normal sexual functioning. However, there is the issue of his penis looking somewhat unusual (the differently-formed foreskin moreso than the placement of the urinary opening), which could be difficult for him both with future sexual partners and if anyone in a locker room, etc happens to notice. My husband especially feels that young people have enough stacked against them in the insecurity department without adding embarrassment about one's genitals. He also thinks that if the surgery is done now, the healing will go more quickly than it would if it were performed later in our son's life (confirmed by the urologist) and our son won't remember, which will minimize the chance of any kind of emotional trauma and/or sexual hangups.
I realize this situation doesn't have a cut-and-dried answer, but I guess I just respect many of the members of this community and was interested in your thoughts on whether a procedure of this sort, that basically qualifies as cosmetic surgery), is warranted. If you've faced a similar situation, either as a parent or a child, I'd especially appreciate hearing from you. I've read so many things -- from descriptions of people who were relieved to be "normalized" by the surgery, to intersex websites that suggest hypospadias repair is traumatic and a form of mutilation -- and I'd like to more thoroughly consider all sides. Thank you in advance.
This exercise may sound silly, but it'll be helpful. I promise. Answer the following questions:
1a: If you do it, what's the best possible outcome?
1b: What's the worst?
2a: If you don't do it, what's the best possible outcome?
2b: What's the worst?
Then:
Is the answer to 1a so much better than 2b that it's worth risking 1b and losing 2a for?
posted by Jairus at 3:37 PM on June 24, 2007 [3 favorites]
1a: If you do it, what's the best possible outcome?
1b: What's the worst?
2a: If you don't do it, what's the best possible outcome?
2b: What's the worst?
Then:
Is the answer to 1a so much better than 2b that it's worth risking 1b and losing 2a for?
posted by Jairus at 3:37 PM on June 24, 2007 [3 favorites]
his hypospadias is so mild that he should be able to urinate normally (though he might have to sit)
My feeling, without all the other stuff is that this part is a Really Big Deal. Being a boy who has to sit when you pee really makes you stand out from the other boys in ways that matter and that goes well beyond the cosmetic. If almost all problems (beyond the anesthesia risks) are correctable if anything goes wrong, I think worrying about your son's pain is something that you either have to deal with now or at some point later when something else comes up.
posted by jessamyn at 3:42 PM on June 24, 2007 [7 favorites]
My feeling, without all the other stuff is that this part is a Really Big Deal. Being a boy who has to sit when you pee really makes you stand out from the other boys in ways that matter and that goes well beyond the cosmetic. If almost all problems (beyond the anesthesia risks) are correctable if anything goes wrong, I think worrying about your son's pain is something that you either have to deal with now or at some point later when something else comes up.
posted by jessamyn at 3:42 PM on June 24, 2007 [7 favorites]
If not, maybe you can let him decide whether to have the surgery when he gets a little older?
All else being equal, I would argue that now is almost definitely a better time. If I had to face the possibility of a penis surgery at age 10 I would have been scared shitless.
posted by dhammond at 3:48 PM on June 24, 2007
All else being equal, I would argue that now is almost definitely a better time. If I had to face the possibility of a penis surgery at age 10 I would have been scared shitless.
posted by dhammond at 3:48 PM on June 24, 2007
To elaborate on Jessamyn's comment, you might pull up the New York Times' recent article on gynecomastia (i.e., development of the breast tissue in males), and the impact it has on boys. Medically, the two conditions are nothing alike, but it may give you an idea of what a boy perceived as "feminine" in one respect may encounter, even when it is a medical condition.
Tough call, and I am no doctor. Good luck on your decision.
posted by Admiral Haddock at 3:55 PM on June 24, 2007
Tough call, and I am no doctor. Good luck on your decision.
posted by Admiral Haddock at 3:55 PM on June 24, 2007
Best answer: He also thinks that if the surgery is done now, the healing will go more quickly than it would if it were performed later in our son's life (confirmed by the urologist)
That seems decisive to me.
I would not put much hope in the idea that he would have a normal, unaffected life if you leave it untreated. It might not be the defining characteristic of his life or anything like that, but the genital deformity that forces him to sit to urinate and that he thinks about any time he pulls down his pants in front of a new sex partner, or has to warn them about ahead of time, is not going to be nothing.
Only you can judge the risk of the procedure against the for-sure psychological costs of not getting it done. And, frankly, I think that waiting for him to decide is just passing the buck on a difficult decision. Making difficult decisions for their kids is part of a parent's job.
posted by ROU_Xenophobe at 3:56 PM on June 24, 2007 [1 favorite]
That seems decisive to me.
I would not put much hope in the idea that he would have a normal, unaffected life if you leave it untreated. It might not be the defining characteristic of his life or anything like that, but the genital deformity that forces him to sit to urinate and that he thinks about any time he pulls down his pants in front of a new sex partner, or has to warn them about ahead of time, is not going to be nothing.
Only you can judge the risk of the procedure against the for-sure psychological costs of not getting it done. And, frankly, I think that waiting for him to decide is just passing the buck on a difficult decision. Making difficult decisions for their kids is part of a parent's job.
posted by ROU_Xenophobe at 3:56 PM on June 24, 2007 [1 favorite]
Best answer: 3-4% risk of unspecified complications is worth the risk. Don't let your son go through life with a disfigured penis. I bet that if he had to make this choice at 18, he'd take a 75% risk of complications to make himself normal.
posted by rxrfrx at 3:56 PM on June 24, 2007
posted by rxrfrx at 3:56 PM on June 24, 2007
Response by poster: Jairus, I appreciate the gist of the exercise you proposed and can see its value...I guess I'm having trouble answering the questions realistically and reasonably, without being too alarmist. For example:
1a: Best possible outcome is our son has a completely normal-looking and -functioning penis, with no resulting emotional or physical trauma.
1b: Worst possible outcome (in my wildest imagination) is he dies in surgery, or second worst, his penis becomes completely deformed and non-functioning. More realistically, a bad outcome would be that he develops hardened scar tissue that results in painful erections or erectile dysfunction, and all the related trauma.
2a: Best possible outcome is he is a very thick-skinned kid/teen/man who isn't bothered by his differences, and that he encounters sexual partners who are understanding.
2b: Worst possible outcome is he is teased mercilessly in locker rooms, his attempts at sexual relationships are humiliating, and he becomes withdrawn and depressed for being different. And, possibly, that he resents his dad and I for not fixing it early.
I don't honestly know how to apply your formula, when it comes to remote physical risks vs. more likely emotional ones. Obviously hurting our son emotionally is preferable to destroying him physically, but if the procedure isn't as big a deal as I'm worrying about, I'd hate to wreck my son's self esteem, confidence, and relationships because I'm a big puss.
posted by justonegirl at 3:58 PM on June 24, 2007 [1 favorite]
1a: Best possible outcome is our son has a completely normal-looking and -functioning penis, with no resulting emotional or physical trauma.
1b: Worst possible outcome (in my wildest imagination) is he dies in surgery, or second worst, his penis becomes completely deformed and non-functioning. More realistically, a bad outcome would be that he develops hardened scar tissue that results in painful erections or erectile dysfunction, and all the related trauma.
2a: Best possible outcome is he is a very thick-skinned kid/teen/man who isn't bothered by his differences, and that he encounters sexual partners who are understanding.
2b: Worst possible outcome is he is teased mercilessly in locker rooms, his attempts at sexual relationships are humiliating, and he becomes withdrawn and depressed for being different. And, possibly, that he resents his dad and I for not fixing it early.
I don't honestly know how to apply your formula, when it comes to remote physical risks vs. more likely emotional ones. Obviously hurting our son emotionally is preferable to destroying him physically, but if the procedure isn't as big a deal as I'm worrying about, I'd hate to wreck my son's self esteem, confidence, and relationships because I'm a big puss.
posted by justonegirl at 3:58 PM on June 24, 2007 [1 favorite]
Every woman with whom I've ever had the subject come up is jealous of men, that we can stand up to pee. Seconding Jessamyn on standing out from other boys.
Sure it's going to be excruciating for the lad, but he's so young that he won't remember it.
posted by notsnot at 4:02 PM on June 24, 2007
Sure it's going to be excruciating for the lad, but he's so young that he won't remember it.
posted by notsnot at 4:02 PM on June 24, 2007
a 96% chance of having a normal life sounds like a bargain to me. i wouldn't wait till he's old enough to know what's happening. in the tiny event that there -are- complications, you can get it dealt with before he notices his differences.
i'm all for people accepting and learning to love their differences, but this is easily fixed with low risk and large psychological benefit.
posted by thinkingwoman at 4:04 PM on June 24, 2007
i'm all for people accepting and learning to love their differences, but this is easily fixed with low risk and large psychological benefit.
posted by thinkingwoman at 4:04 PM on June 24, 2007
Coming from a thick-skinned kid/teen/man (20): I'd be pretty pissed off if I'd had this problem and my parents hadn't taken the opportunity to correct it.
posted by tumult at 4:05 PM on June 24, 2007
posted by tumult at 4:05 PM on June 24, 2007
Best answer: What a tough situation! I have two twelve year old boys. They will pick on each other mercilessly at times (yes, I have taught them better, but once they run in a pack, they degenerate). He will be picked on badly if he has to sit down while peeing. He'll be picked on really badly. I do think it's better to have the surgery done now before he's got all the baggage around his penis and while he'll heal with less complications.
My son had to have an adenoictomy and tonsillectomy a few months ago and I was a nervous wreck due to my fears before the surgery. Your son would want the surgery, even with the risks, as he gets older. You will have to pay the mommy price of the fear and anxiety.
When boys turn into a pack, they can get stupid and mean, and if there are three of them, they will gang up on the third. This happens irregardless of the years of careful parenting. They'll hurt his feelings and you'll feel anguish. You can't protect your son from all the teasings, but maybe you can protect him from that particular one. Good luck with your choice.
posted by aliksd at 4:11 PM on June 24, 2007
My son had to have an adenoictomy and tonsillectomy a few months ago and I was a nervous wreck due to my fears before the surgery. Your son would want the surgery, even with the risks, as he gets older. You will have to pay the mommy price of the fear and anxiety.
When boys turn into a pack, they can get stupid and mean, and if there are three of them, they will gang up on the third. This happens irregardless of the years of careful parenting. They'll hurt his feelings and you'll feel anguish. You can't protect your son from all the teasings, but maybe you can protect him from that particular one. Good luck with your choice.
posted by aliksd at 4:11 PM on June 24, 2007
Best answer: I think Jairus' exercise needs to be amended by likelyhood. The chances of complications are 3%, and the chances of SERIOUS complications are probably much, much lower. The chances of him feeling different and weird, at least sometimes, are 100%. Even a thick-skinned person knows he is different, and will be psychologically hindered by something like this. You are pitting a very, very small chance of hurting him physically against an almost certainty of hurting him mentally.
posted by almostmanda at 4:12 PM on June 24, 2007
posted by almostmanda at 4:12 PM on June 24, 2007
I think that the peeing issue is not the only one. Besides the possibility of a less-than-understanding potential sexual partner from an aesthetic point of view, I would add that it might result in discomfort during sexual activity.
I would recommend having the procedure done, and having it done while your son is young. This is based on the experience of a friend of mine whose son had to undergo circumcision at the age of 12 because of a problem with recurrent infections. Obviously, they were very concerned. Their son had almost no pain, healed very quickly, and was glad to be "like the other boys."
posted by misha at 4:17 PM on June 24, 2007
I would recommend having the procedure done, and having it done while your son is young. This is based on the experience of a friend of mine whose son had to undergo circumcision at the age of 12 because of a problem with recurrent infections. Obviously, they were very concerned. Their son had almost no pain, healed very quickly, and was glad to be "like the other boys."
posted by misha at 4:17 PM on June 24, 2007
My son was born with extreme hypospadias, to the point where they couldn't determine his sex without genetic testing. We did have surgery performed and absolutely do not regret it, as very young kids are amazingly resilient. It is true that the older he gets, the more traumatic it will be and the harder the recovery will be. As a guy I can also agree with others who have said it is a major deal being able to stand to pee. Talk over all of your concerns with the surgeon, and if s/he isn't willing to talk with you and address your concerns, find another surgeon. If you would like to talk feel free to contact me separately.
posted by mattholomew at 4:29 PM on June 24, 2007
posted by mattholomew at 4:29 PM on June 24, 2007
Response by poster: Thanks so much, everyone, for the responses so far (and thanks in advance to anyone else who might be willing to offer their thoughts). I feel reassured knowing that most people here seem to not think it shallow to place a high value on my son's aesthetic similarity to other boys. It's good to know most seem to not believe he'll feel "mutilated" or traumatized.
mattholomew, I'd love to talk but I don't see an email in your profile; could you write me?
posted by justonegirl at 4:35 PM on June 24, 2007
mattholomew, I'd love to talk but I don't see an email in your profile; could you write me?
posted by justonegirl at 4:35 PM on June 24, 2007
Best answer: Dear justonegirl;
My 11th month old son recently was circumcised due to extreme phimosis, and after he was circumcised they discovered that he was also born with mild hypospadias as well. (He ended up being in surgery almost two hours rather than the 40 minutes that was prediected; there were significant abnormalities of the way his foreskin attached to his scrotal skin and our surgeon ended up doing some signifcant reconstructive work to put everything where it is supposed to be - I'm given to undersand that abnormalities of the foreskin are almost always associated with hypospadias.) One thing that our urologist told us after the surgery was that it "makes sense, in retrospect" that he has the hypospadias, since the original reason for the circumcision was that he was getting repeated, progressively severe urinary tract infections, which our urologist said were "not unusual" in an uncircumcised boy who had both conditions. (He also said that he's seen more hypospadias in the past five years than he had in the previous ten years of his practice. Its becoming more common, and no one seems to know why.) You might want to ask about the possiblity of future UTIs and other medical problems that could be related to the condition, and see if that helps make your decision.
We are lucky in that his hypospadias is very mild; it probably won't affect his ability to urinate while standing when he's older, although its obviously too soon to tell. However, I will say that I agonized -- agonized over the decision to have the surgery to correct the phimosis, for many of the reasons you discuss above -- however in retrospect I'm glad we did it because it (obviously) revealed other problems that we didn't know about prior to the surgery.
Everything else being equal, my advice is to do it. Babies heal much faster than older children, and it is better to have it done now than later. Also, our son was given some kind of long-lasting numbing injection at the end of his surgery which made him pain free for the first 24 hours, which I'm given to understand is the standard in genital surgery in infants and children these days. The most terrifying part is handing him over for the anesthisia; the idea that he somehow "won't wake up" haunted me for days prior to the surgery - however, that is very, very rare in healthy infants.
What turned the tide for me, honestly, was reading the experiences of people who had similar surgeries done as teens and adults - without question, they all said how scary and awful it was -- that the pain wasn't anything in comparison to the scaryness prior to the proceedure. Having this done while he's an infant will avoid that.
Good luck, and remember that you are a great mom no matter what you decide. My email is in my profile if you want to talk more about this off-line.
posted by anastasiav at 4:37 PM on June 24, 2007
My 11th month old son recently was circumcised due to extreme phimosis, and after he was circumcised they discovered that he was also born with mild hypospadias as well. (He ended up being in surgery almost two hours rather than the 40 minutes that was prediected; there were significant abnormalities of the way his foreskin attached to his scrotal skin and our surgeon ended up doing some signifcant reconstructive work to put everything where it is supposed to be - I'm given to undersand that abnormalities of the foreskin are almost always associated with hypospadias.) One thing that our urologist told us after the surgery was that it "makes sense, in retrospect" that he has the hypospadias, since the original reason for the circumcision was that he was getting repeated, progressively severe urinary tract infections, which our urologist said were "not unusual" in an uncircumcised boy who had both conditions. (He also said that he's seen more hypospadias in the past five years than he had in the previous ten years of his practice. Its becoming more common, and no one seems to know why.) You might want to ask about the possiblity of future UTIs and other medical problems that could be related to the condition, and see if that helps make your decision.
We are lucky in that his hypospadias is very mild; it probably won't affect his ability to urinate while standing when he's older, although its obviously too soon to tell. However, I will say that I agonized -- agonized over the decision to have the surgery to correct the phimosis, for many of the reasons you discuss above -- however in retrospect I'm glad we did it because it (obviously) revealed other problems that we didn't know about prior to the surgery.
Everything else being equal, my advice is to do it. Babies heal much faster than older children, and it is better to have it done now than later. Also, our son was given some kind of long-lasting numbing injection at the end of his surgery which made him pain free for the first 24 hours, which I'm given to understand is the standard in genital surgery in infants and children these days. The most terrifying part is handing him over for the anesthisia; the idea that he somehow "won't wake up" haunted me for days prior to the surgery - however, that is very, very rare in healthy infants.
What turned the tide for me, honestly, was reading the experiences of people who had similar surgeries done as teens and adults - without question, they all said how scary and awful it was -- that the pain wasn't anything in comparison to the scaryness prior to the proceedure. Having this done while he's an infant will avoid that.
Good luck, and remember that you are a great mom no matter what you decide. My email is in my profile if you want to talk more about this off-line.
posted by anastasiav at 4:37 PM on June 24, 2007
My wife said something once, when we circumcised our newborn son. "I'm sorry, kid, but this is so your future girlfriends won't laugh at you."
Get it done, it's a no-brainer. You'll look back on this 2-3 years from now when you're potty-training and chuckle that you thought it was a big deal.
posted by Cool Papa Bell at 5:08 PM on June 24, 2007
Get it done, it's a no-brainer. You'll look back on this 2-3 years from now when you're potty-training and chuckle that you thought it was a big deal.
posted by Cool Papa Bell at 5:08 PM on June 24, 2007
My opinion, which I offer as simply that, is that you should have the operation done now as the surgeon recommended.
posted by ikkyu2 at 5:33 PM on June 24, 2007
posted by ikkyu2 at 5:33 PM on June 24, 2007
It is so hard to say without pictures, but really please don't as if you did he would have a legitimate reason for patricide later. No kid wants to look strange, especially to have strange genitals. If it really is going to be different then please do him a favor and correct it now. Only you can decide, because hypospadias includes everything from slightly off center to a hole in the side of the shaft. Failing to correct the latter would be so wrong, yet perhaps the former is nothing. Basically, life is hard enough for kids and having to deal with some sort of genital defect is not a stress you want to put him through if he doesn't have to. I would err on the side of surgery, but it all comes down to whether the defect is big enough to be noticeable. (Having to sit down to pee is way, way over the line of noticeable "Hey George, I mean Georgia, how come you pee like a girl?" Oh yeah, he will want to hear that in school.)
posted by caddis at 6:58 PM on June 24, 2007
posted by caddis at 6:58 PM on June 24, 2007
My husband had corrective surgery for hypospadias when he was 20. The urologist (who looked like Al Gore, apparently) said that the condition must have been mild enough for DH's mom to not notice during his formative years. However, the whole reason he had to have the surgery at 20 was that the condition had steadily gotten worse as he aged, to the point where he ended up in the emergency room.
It may not be the case for your son, but it is something to think about.
posted by oflinkey at 7:50 PM on June 24, 2007
It may not be the case for your son, but it is something to think about.
posted by oflinkey at 7:50 PM on June 24, 2007
By "gotten worse" I should specify-- his urethra steadily narrowed from the stress the misplaced opening put on his urinary tract.
posted by oflinkey at 7:52 PM on June 24, 2007
posted by oflinkey at 7:52 PM on June 24, 2007
Speaking as a guy, not being able to pee standing up would be a huge social deformity--far greater than the physical deformity--especially in the cruel school years. I wouldn't hesitate to let a competent surgical team perform the operation.
posted by stevis23 at 8:30 PM on June 24, 2007
posted by stevis23 at 8:30 PM on June 24, 2007
My son had surgery for a hydrocele (it is a painless buildup of watery fluid around one or both testicles that causes the scrotum or groin area to swell) when he was 2. It was very scary to think of him undergoing general anesthesia. His surgery was done at Children’s Hospital in New Orleans.
The staff was wonderful! We stayed with him until an OR nurse came to get him, with a red helium balloon in one hand. She carried him in her arms, letting him hold the balloon. His surgery was about 2 hours. When he was in the recovery room, they had us standing next to his bed as he started to wake. The ped urologist said that he would be running around in a few days, he told us that an adult would be flat on his back for 6 weeks with the same surgery.
His surgery was outpatient, we were able to bring him home that afternoon. He slept most of that first evening. The second day he was moving pretty good, just couldn’t climb. Third day, I was chasing him around, trying to keep him quite, what a joke!
His incision was in the crease right above the pubic area. Six months later you could not even see the scar.
My recommendation is get the surgery done now. His recovery time will be days instead of weeks. Best of luck to him, I’m sure he’ll do fine.
posted by JujuB at 8:48 PM on June 24, 2007
The staff was wonderful! We stayed with him until an OR nurse came to get him, with a red helium balloon in one hand. She carried him in her arms, letting him hold the balloon. His surgery was about 2 hours. When he was in the recovery room, they had us standing next to his bed as he started to wake. The ped urologist said that he would be running around in a few days, he told us that an adult would be flat on his back for 6 weeks with the same surgery.
His surgery was outpatient, we were able to bring him home that afternoon. He slept most of that first evening. The second day he was moving pretty good, just couldn’t climb. Third day, I was chasing him around, trying to keep him quite, what a joke!
His incision was in the crease right above the pubic area. Six months later you could not even see the scar.
My recommendation is get the surgery done now. His recovery time will be days instead of weeks. Best of luck to him, I’m sure he’ll do fine.
posted by JujuB at 8:48 PM on June 24, 2007
It sounds like it's worth doing to prevent possible future complications.
CDC article on the increase in hypospadias.
posted by BrotherCaine at 1:50 AM on June 25, 2007
CDC article on the increase in hypospadias.
posted by BrotherCaine at 1:50 AM on June 25, 2007
I've done a fair amount of research on infant genital surgeries in the U.S. (as part of my master's thesis). Many adults experience deep regret, anger, and trauma from these surgeries. However, there are various reasons for this reaction, which I would roughly sum up as:
1) severity of the operation: in many cases the surgeries are significantly more invasive than the one on your son. This category is not likely to be a factor in how your son feels about the operation.
2) number of operations: in cases where something turns out to be difficult or goes wrong many operations may be needed, well past infancy. This can become quite traumatic. During your appointment, I would ask your doctor how many of this type of surgeries he's performed, and of those surgeries how many needed a second operation. How many needed more than 2 operations? If it's a large number, then you have some reason to reconsider. After all, the point of doing it young is to have him not remember it. If he's likely to get 20 operations over 10 years, you might as well wait. On the other hand, if there have only ever been, say, 2/100 repeats with a hypospadias of this degree, then you can feel confident that getting it done now will prevent the trauma of surgery when he's older.
3) doctor cruelty: some adults have stories of being treated as medical specimens by doctors and med students: striped naked, talked about in derogatory language, photographed, laughed at. Again, this seems unlikely in your son's case, as hypospadias is relatively common and relatively uninteresting from a surgical perspective.
4) "Shame and Secrecy": Many children who had genital surgeries were not informed by their parents, or were told not to discuss it. This is not a direct result of surgery, obviously, but of how it and the underlying condition are presented to your son. You can work to prevent these feelings which ever way you choose. In my opinion (I compared these types of surgeries with similarly extensive ones that were celebrated in their communities), this may be the major factor in the trauma that many adults feel. The sense that their parents and doctors did this because there was something wrong and shameful about their bodies combines with the fact that surgery most often does not produce genitals that are indistinguishable from so-called 'normal' ones to perpetuate rather than alleviate a sense that there is something wrong and shameful about their body and maybe about their person overall. There are a growing number of councillors who specialize in helping parents deal with genital surgeries and their underlying conditions in ways that don't create this trauma for their children, which ever surgical decision you make.
I will add to this that I know a guy who had a minor hypospadia corrected, and never thought much about it. He was completely happy with his life and his parents' choice. It wasn't completely corrected (and he did need multiple surgeries), but he doesn't have any trouble with girlfriends or any regrets. This is a difficult choice to make, and the "best" choice is essentially unknowable. The best you can do is to be as informed as possible.
In the interest of being as informed as possible and in helping you come up with some questions for your surgeon, I suggest you read this from the ISNA (Intersex Society of North America). Realize first that they are against any cosmetic surgery on infants; they represent people who have been unhappy with their surgeries. I am not pointing to this to say that you shouldn't, but because they represent "the other side" to the surgeon's inevitable pro-surgery position. Hopefully this information will help you come up with some good questions for your consultation, and some concrete ways of weighing the pros and cons of the surgery.
posted by carmen at 6:31 AM on June 25, 2007 [1 favorite]
1) severity of the operation: in many cases the surgeries are significantly more invasive than the one on your son. This category is not likely to be a factor in how your son feels about the operation.
2) number of operations: in cases where something turns out to be difficult or goes wrong many operations may be needed, well past infancy. This can become quite traumatic. During your appointment, I would ask your doctor how many of this type of surgeries he's performed, and of those surgeries how many needed a second operation. How many needed more than 2 operations? If it's a large number, then you have some reason to reconsider. After all, the point of doing it young is to have him not remember it. If he's likely to get 20 operations over 10 years, you might as well wait. On the other hand, if there have only ever been, say, 2/100 repeats with a hypospadias of this degree, then you can feel confident that getting it done now will prevent the trauma of surgery when he's older.
3) doctor cruelty: some adults have stories of being treated as medical specimens by doctors and med students: striped naked, talked about in derogatory language, photographed, laughed at. Again, this seems unlikely in your son's case, as hypospadias is relatively common and relatively uninteresting from a surgical perspective.
4) "Shame and Secrecy": Many children who had genital surgeries were not informed by their parents, or were told not to discuss it. This is not a direct result of surgery, obviously, but of how it and the underlying condition are presented to your son. You can work to prevent these feelings which ever way you choose. In my opinion (I compared these types of surgeries with similarly extensive ones that were celebrated in their communities), this may be the major factor in the trauma that many adults feel. The sense that their parents and doctors did this because there was something wrong and shameful about their bodies combines with the fact that surgery most often does not produce genitals that are indistinguishable from so-called 'normal' ones to perpetuate rather than alleviate a sense that there is something wrong and shameful about their body and maybe about their person overall. There are a growing number of councillors who specialize in helping parents deal with genital surgeries and their underlying conditions in ways that don't create this trauma for their children, which ever surgical decision you make.
I will add to this that I know a guy who had a minor hypospadia corrected, and never thought much about it. He was completely happy with his life and his parents' choice. It wasn't completely corrected (and he did need multiple surgeries), but he doesn't have any trouble with girlfriends or any regrets. This is a difficult choice to make, and the "best" choice is essentially unknowable. The best you can do is to be as informed as possible.
In the interest of being as informed as possible and in helping you come up with some questions for your surgeon, I suggest you read this from the ISNA (Intersex Society of North America). Realize first that they are against any cosmetic surgery on infants; they represent people who have been unhappy with their surgeries. I am not pointing to this to say that you shouldn't, but because they represent "the other side" to the surgeon's inevitable pro-surgery position. Hopefully this information will help you come up with some good questions for your consultation, and some concrete ways of weighing the pros and cons of the surgery.
posted by carmen at 6:31 AM on June 25, 2007 [1 favorite]
Just to add to the anecdotals on sooner rather than later in life surgery -- my daughter had four major surgeries before the age of 8, two of which could have 'waited' until she was old enough to decide for herself. I accompanied her into the operating room each time, and soothed her into anaesthesia.
It was terribly difficult for me, watching her 'go under' so if you decide to do it, steel yourself -- but now that she's 21, it's not even a glimmer of a memory for her. She thanks me for not waiting and letting it be her decision. It was definitely the right thing to do (although as with so much of my kids' childhood traumas and tragedies, harder on me!)
posted by thinkpiece at 8:30 AM on June 25, 2007
It was terribly difficult for me, watching her 'go under' so if you decide to do it, steel yourself -- but now that she's 21, it's not even a glimmer of a memory for her. She thanks me for not waiting and letting it be her decision. It was definitely the right thing to do (although as with so much of my kids' childhood traumas and tragedies, harder on me!)
posted by thinkpiece at 8:30 AM on June 25, 2007
Of course you're scared--the prospect is cutting your son. What would you want your parents to do in this situation? I would want them to correct the abnormality. Most kids have no idea of how to make a correct decision before the age of 25 anyway--it would be a joke to ask a child to make a decision about surgery. You're the parent.
Surgery happens on kids all the time with very successful results. Just do it and stop overanalyzing yourself.
posted by FergieBelle at 12:38 PM on June 25, 2007
Surgery happens on kids all the time with very successful results. Just do it and stop overanalyzing yourself.
posted by FergieBelle at 12:38 PM on June 25, 2007
I've had to take my infant son for three operations requiring general anesthesia, two on the testicles.
It's horrid. But, from what you describe in the question, I would have absolutely no qualms about getting the surgery done now.
Sitting to pee is enough of a difference to make him feel very exposed when he's older.
posted by Pericles at 12:56 PM on June 25, 2007
It's horrid. But, from what you describe in the question, I would have absolutely no qualms about getting the surgery done now.
Sitting to pee is enough of a difference to make him feel very exposed when he's older.
posted by Pericles at 12:56 PM on June 25, 2007
Just as a heads up, ISNA is the Intersex Society of North America, and there is nothing here to suggest that your son is or is not intersexed.
ISNA deals primarily with the issue of sex reassignment for infants, which I agree is a truly ghastly proposal. I would say that his anatomy is close enough to "standard for male" that if anyone looked at his penis they would instantly know it was a penis. It sounds like his diagnosis means it's not immediately apparent that his opening is in the wrong place. If the degree of the specific problem would warrant surgery if it were another part of his body, say his nose or ear I'd go ahead. Would it? I mean, if you found out he could have perfectly good hearing with a hearing aid, or some aspect of his appearance would be a little different from other children, would you have an elective surgery? What if you found out one of his legs was going to be a tiny bit different in length, but he could wear special shoes?
If your concern is about him being physically handicapped or made fun of at all, I feel that is different from a concern being about his appearing "like a girl." Please be honest with yourself about that being your deciding factor. Gender issues in childhood are many and varied. Between age 5 and 8 kids are most aware of and most vehement about enforcing gender stereotypes, teenagers are not the most verbally abusive about these issues.
Also, realize that there are a lot of folks who contend that these surgical fixes to urogenital problems are very new, appearing most specifically with psychologist Dr. John Money in 1950s, 1960s and advances in medical technology. ISNA and other groups are quick to point out that a lot of people who were intersexed (which again, your son is likely not) had fulfilling lives with no medical intervention. In fact. Dr. Money wrote his doctoral dissertation (never published) about the life satisfaction of intersexed individuals. He found that by and large they were fine, mentally and physically. His later work never mentions that research and his official medical/psychological stance was that children must be made to conform to social norms of physical maleness or femaleness.
If you want a truly horrifying story of a botched genital surgery on a little boy, look into As Nature Made Him by John Colapinto. It's gut wrenching and tells the story of a little boy whose circumsicion went wrong and he was unsuccessfully raised as a girl in Canada. This might be your marker for worst case outcome of the surgery. If you can get your hands on the dissertation by Dr. Money, (it is mentioned in the afterword of the Colapinto book) that might give you an idea of your best case scenario with no surgery.
posted by bilabial at 7:23 AM on June 26, 2007
ISNA deals primarily with the issue of sex reassignment for infants, which I agree is a truly ghastly proposal. I would say that his anatomy is close enough to "standard for male" that if anyone looked at his penis they would instantly know it was a penis. It sounds like his diagnosis means it's not immediately apparent that his opening is in the wrong place. If the degree of the specific problem would warrant surgery if it were another part of his body, say his nose or ear I'd go ahead. Would it? I mean, if you found out he could have perfectly good hearing with a hearing aid, or some aspect of his appearance would be a little different from other children, would you have an elective surgery? What if you found out one of his legs was going to be a tiny bit different in length, but he could wear special shoes?
If your concern is about him being physically handicapped or made fun of at all, I feel that is different from a concern being about his appearing "like a girl." Please be honest with yourself about that being your deciding factor. Gender issues in childhood are many and varied. Between age 5 and 8 kids are most aware of and most vehement about enforcing gender stereotypes, teenagers are not the most verbally abusive about these issues.
Also, realize that there are a lot of folks who contend that these surgical fixes to urogenital problems are very new, appearing most specifically with psychologist Dr. John Money in 1950s, 1960s and advances in medical technology. ISNA and other groups are quick to point out that a lot of people who were intersexed (which again, your son is likely not) had fulfilling lives with no medical intervention. In fact. Dr. Money wrote his doctoral dissertation (never published) about the life satisfaction of intersexed individuals. He found that by and large they were fine, mentally and physically. His later work never mentions that research and his official medical/psychological stance was that children must be made to conform to social norms of physical maleness or femaleness.
If you want a truly horrifying story of a botched genital surgery on a little boy, look into As Nature Made Him by John Colapinto. It's gut wrenching and tells the story of a little boy whose circumsicion went wrong and he was unsuccessfully raised as a girl in Canada. This might be your marker for worst case outcome of the surgery. If you can get your hands on the dissertation by Dr. Money, (it is mentioned in the afterword of the Colapinto book) that might give you an idea of your best case scenario with no surgery.
posted by bilabial at 7:23 AM on June 26, 2007
bilabial, intersex is an umbrella term that refers to a number of conditions including hypospadias. It is not defined as the inability to tell if a child is male or female, although a number of intersex conditions can have that effect. The link I provided contained the ISNA's stance on infant surgical correction of hypospadias, including some information about side effects that the poster may not have been aware of and may have wanted to ask about, such as the possibility of the skin used to extend the urethra growing hair. I did not link the ISNA in order to suggest that there was any question of the child's gender, and the poster did not mention that as a concern.
As Nature Made Him is the story of a boy whose routine circumcision was botched and whose parents were convinced by John Money that it would be best to raise him as a girl. It is a tragic story, but it does not have much application in this case, and I can't imagine that it would help justonegirl make a decision about her son, and may only serve to make her feel more worried/guilty over surgery than is warrented.
Ultimately this is a difficult decision that holds in common with decisions about more drastic intersex surgeries the difficult prospect of weighing potentially bad social situations against medical risks. The pros and cons of either side can be difficult to weigh, and I provided the ISNA information to hopefully increase the information the parents could use, not to suggest that there was anything obvious about what choice they should make or that there is any gender confusion about their son.
posted by carmen at 7:54 AM on June 26, 2007
As Nature Made Him is the story of a boy whose routine circumcision was botched and whose parents were convinced by John Money that it would be best to raise him as a girl. It is a tragic story, but it does not have much application in this case, and I can't imagine that it would help justonegirl make a decision about her son, and may only serve to make her feel more worried/guilty over surgery than is warrented.
Ultimately this is a difficult decision that holds in common with decisions about more drastic intersex surgeries the difficult prospect of weighing potentially bad social situations against medical risks. The pros and cons of either side can be difficult to weigh, and I provided the ISNA information to hopefully increase the information the parents could use, not to suggest that there was anything obvious about what choice they should make or that there is any gender confusion about their son.
posted by carmen at 7:54 AM on June 26, 2007
Hypospadias is not such a simple thing as many may believe. I also have a son with a mild hypospadias and deciding whether or not to have surgery was one of the hardest things I've ever had to go through. It seems as if, to the doctors, going ahead with surgery was a must for any child. Their reasons were some of the same you mention(standing to pee, locker room horror etc) which, I must say, are very important issues to boys and men. What many surgeons haven't seen is the emotional toll surgery has had on these boys as they grow. We were told my son would probably never stand to pee without surgery. He is now 5 and doing fine.
Even if a surgery is performed a child will always know they are a bit different. The most important thing, over surgery, is raising your child to be self-confident. I have spoken with many men over the years who have hypospadias both corrected and uncorrected. Some men wish they had had surgery as a baby, some wish they had never had surgery. I did find though that those I met with mild hypospadias that never had surgery seemed the most content. The biggest issue in most of the men I talk with is whether or not their parents spoke with them about it as they grew. Your son must know what hypospadias is. Let him know all penises are different just like all noses, ears and eyes.
The decision to have surgery is a personal one but take your time if you are not sure. This is not a life-threatening issue. Get all the information you need. If you do go ahead with surgery, make sure you talk about this as he grows so if issues come up later in life he can feel comfortable enough to come to you for help.
posted by Fnew at 9:04 AM on July 9, 2007
Even if a surgery is performed a child will always know they are a bit different. The most important thing, over surgery, is raising your child to be self-confident. I have spoken with many men over the years who have hypospadias both corrected and uncorrected. Some men wish they had had surgery as a baby, some wish they had never had surgery. I did find though that those I met with mild hypospadias that never had surgery seemed the most content. The biggest issue in most of the men I talk with is whether or not their parents spoke with them about it as they grew. Your son must know what hypospadias is. Let him know all penises are different just like all noses, ears and eyes.
The decision to have surgery is a personal one but take your time if you are not sure. This is not a life-threatening issue. Get all the information you need. If you do go ahead with surgery, make sure you talk about this as he grows so if issues come up later in life he can feel comfortable enough to come to you for help.
posted by Fnew at 9:04 AM on July 9, 2007
Dear justonegirl
I am just wondering how your son got on with the surgery? My son has exactly the same condition. He is 4and half months old and will be having surgery in a couple of months. I am in the UK where circumcision isn't very common so i am quite worried about putting him through this because either way he is going to look a bit 'different' whatever i decide. I have heard of a procedure called GRAP where they can use the foreskin to make it look like a normal uncircumcised penis but i haven't heard of anyone having this done. What sort of procedure did your son have? And do you know if it will have any impact on his future having this condition? Sorry for all the questions but as i'm sure you know it is hard to put them through this when so young (and my first baby). I would appreciate any advice you could give. Thank you.
posted by seahorse at 3:29 AM on August 21, 2007
I am just wondering how your son got on with the surgery? My son has exactly the same condition. He is 4and half months old and will be having surgery in a couple of months. I am in the UK where circumcision isn't very common so i am quite worried about putting him through this because either way he is going to look a bit 'different' whatever i decide. I have heard of a procedure called GRAP where they can use the foreskin to make it look like a normal uncircumcised penis but i haven't heard of anyone having this done. What sort of procedure did your son have? And do you know if it will have any impact on his future having this condition? Sorry for all the questions but as i'm sure you know it is hard to put them through this when so young (and my first baby). I would appreciate any advice you could give. Thank you.
posted by seahorse at 3:29 AM on August 21, 2007
My son is 7 1/2 months old and just had surgery for hypospadias yesterday. He is crawling around and doing great! He had a very minor hypospadias where the hole was maybe 2 mm below where it should have been so the Dr. left it up to us to do it. He simply said that his ability to have children wouldn't be affected since the hole is still pretty close to where it should be so if we chose to do it it would be more for cosmetic purposes. We were a little hesitant at first to do the repair since it was so minor but we knew we wanted him to be circumcised and since they use the skin from the circumcision we knew we needed to just do it all at once since we would be removing the vital component needed for repair. How many 10 or 15 year olds are brave enough to admit to someone....even their parents that they are ready or want their penis "fixed". So, we decided now was the time and boy am I glad. It turns out that once the doctor got in there the hole was actually lower than it looked clinically. It is hard to explain in words and easier to draw a picture. In truth I am just glad it is over and my son is doing great! I know you are torn on many levels....but I would recommend doing this to any parent out there who has the option of doing this. It will be worth it. Kids these days can be so mean and we didn't want our son to have any reason to be self conscious or insecure for any reason...especially when it comes to his "man parts". That would just be terrible. Our decision was made easier after talking to a neighbor of ours. Their son has this and they never got it fixed. He urinates all over his clothes if he stands up to urinate and another friend of ours...her son has to arch his back just to get it in the toilet. This just can't be fun to go through when you are around friends or at school. You also need to factor in the fertility aspect....by not doing the surgery you could be affecting the ability of your child not being able to have biological children. Hope this helps. Good luck to you.
posted by toothfairy98 at 6:10 PM on August 23, 2007 [1 favorite]
posted by toothfairy98 at 6:10 PM on August 23, 2007 [1 favorite]
This thread is closed to new comments.
posted by tastybrains at 3:34 PM on June 24, 2007