Should surgery for hypospadias be performed before an age of consent?

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Available ahead of print online.
Adrienne Carmack, MD, Diplomate, American Board of Urology
Lauren Notini, PhD Candidate in Bioethics, Centre for Health Equity, Melbourne School of Population and Global Health and Department of Paediatrics, University of Melbourne, Parkville, Australia
and Brian D. Earp, Research Associate in Ethics, University of Oxford, Oxford, UK*

Abstract

Hypospadias is a relatively common genital condition in which the urethral opening forms on the underside of the penis, as opposed to at the tip of the glans. Patients with hypospadias are typically referred for surgery during infancy or early childhood. Recent evidence, however, indicates that many individuals with hypospadias do not experience the functional or psychosocial difficulties that are commonly attributed to the condition, and that surgical intervention for hypospadias carries substantial risk of adverse outcomes. In this article, we review published outcomes data and conduct an in-depth analysis of the typical rationales for hypospadias surgery, taking into consideration both the potential benefits and harms of the procedure, as well as the existence of non-surgical alternatives. We argue, firstly, that most childhood surgeries for hypospadias are performed for anticipated future problems concerning function and cosmesis, rather than extant problems that serve to undermine the child’s well-being. Secondly, we contend that the surgery can be safely performed after an age of consent without increasing the absolute risk of surgical complications to an ethically meaningful degree. We conclude that surgery for hypospadias should typically be performed only if requested by the affected individual, under conditions of informed consent.
This is an accepted manuscript; it is currently undergoing typesetting and copy-editing. Some minor changes may be made prior to final publication.
Accepted manuscript—authors’ personal copy. In press.
Please cite as: 
Carmack, A., Notini, L., & Earp, B. D. (in press). Should surgery for hypospadias be performed before an age of consent?
Journal of Sex Research, in press.