Penile agenesis in adult

Penile agenesis (PA) is an extremely rare congenital anomaly with profound surgical and psychosocial consequences. Only seventy five cases have been reported in the literature, the highest age of presentation known seven years. We present a twenty six years old otherwise normal aphallic male with attraction to female sex and night emission through anus. The patient did not agree to the female gender assignment and functioning phallic reconstruction is practically unavailable. Early female gender assignment and feminizing perineal reconstruction (Vaginoplasty) in neonatal cases is the technically easier goal of treatment. Late presenting cases add difficulty to debated decision making of gender assignment.