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Defect Details

Q. Our 6-week-old baby boy was born with a birth defect of his penis, known as hypospadias. The doctor says it is relatively minor and can be surgically repaired. My husband and I keep wondering what caused this defect. I've heard it occurs more commonly in babies who are born to vegetarian mothers, but I have never been a vegetarian. Any ideas?

A.Hypospadias is a relatively common birth defect in boys that causes the urinary opening to be situated below its normal place at the tip of the penis, thus preventing the urine stream from projecting forward. The opening can be located anywhere from just under the tip  -- but still on the head of the penis  -- to a spot somewhere on the lower side of the shaft. Although hypospadias is usually diagnosed at birth, the abnormality has been detected on prenatal ultrasound.

Hypospadias occurs in approximately 1 in 300 newborn boys, and the reported rates appear to have doubled in recent decades, without explanation. Although the cause remains unclear, it is believed to be due to a combination of factors. Among boys born with hypospadias, approximately 8 percent of their fathers and 14 percent of their male siblings also have the condition. It has also been linked to the mother: Increased maternal age, menstrual cycle irregularities, and exposure to drugs during pregnancy  -- especially estrogen hormones  -- are known risk factors, in addition to being sick with influenza in the first trimester of pregnancy. Recently, the possibility has been raised that hormone-like compounds in the mother's diet known as phytoestrogens  -- the richest source being soy  -- may also have an adverse effect on the developing male fetus. A recent British study found that mothers who ate a vegetarian diet during pregnancy (and thus had a greater exposure to phytoestrogens) had a five times greater risk of giving birth to a boy with hypospadias.

Although hypospadias causes no symptoms, surgical correction of the problem by a pediatric urologist is usually recommended. It is typically performed when the baby is about 6 months old (when psychological effects are minimal), although the timing of surgery depends on the child's overall health and the size of his penis. Circumcision, if desired, should not be performed after birth on a boy with hypospadias. Instead, delay it until corrective surgery is performed, because the foreskin will be used in the repair procedure. Fortunately, it sounds as if your son has a mild degree of hypospadias that can be corrected with the suggested surgical repair.