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7 March 2008
Penile Agenesis The Missing Penis
by George Atkinson

Life can be tough for infants born with penile deformities, but spare a thought for baby boys suffering penile agenesis - the complete absence of a penis. First reported in 1853, penile agenesis is an extremely rare developmental anomaly that affects the development of the penis only. The scrotum, testes and testicular function are usually normal. Infants suffering the condition will often exhibit no other abnormalities and have a normal chromosomal make-up.

The usual first course of action to treat the condition involves surgery to shift the urethra to between the scrotal folds which are preserved for subsequent genital reconstruction. Without this corrective surgery, urination is effected through the rectum or via a urethral opening on the perineum (between the scrotum and anus).

This is only a stop gap measure, however, and more surgery follows to assign gender to the infant. Unlike other chromosomal-related conditions, infants with penile agenesis have completely normal testicular hormone function, making them, to all intents and purposes, male. The difficulty in manufacturing a penis from nothing, however, means that the only rational choice open to doctors is to create female genitalia.

The general consensus from the medical profession is that acting early to prevent male gender imprinting is critical. Consequently, removal of the testicles is usually carried out as soon as practicable. Vaginoplasty (the surgical creation of female genitals) is then carried out soon after.

Delaying these measures can result in default male gender assignment and has led to severe psychological and anatomic problems for the infant because of the difficulties associated with constructing a functioning phallus. Doctors involved in penile agenesis treatment say that it is easier to establish a normal female appearance but caution that no reports concerning long term physiological and psychological results exist in gender reassigned patients.

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Source: Indian Association of Pediatric Surgeons
Pic courtesy Indian Association of Pediatric Surgeons

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