Erectile Function and Genital Self-Perception in Young Adults After Childhood Hypospadias Repair: A Case-Control...

Long-term evidence on sexual function and genital self-perception in men operated for hypospadias in childhood remains heterogeneous. This exploratory study evaluated erectile function, genital self-perception, and sexual quality of life in young adults with prior hypospadias repair compared with healthy male volunteers.

Exploratory case-control study compared 17 adult men who underwent hypospadias repair before the age of 4 years between 1995 and 2005 with 19 healthy male volunteers of similar age, without known urogenital anomalies, sexual dysfunction, or relevant cardiometabolic disease. Participants anonymously completed the five-item International Index of Erectile Function (IIEF-5), the Hypospadias Objective Penile Evaluation (HOPE), administered as a self-report measure of perceived penile appearance, and the Sexual Quality of Life-Male (SQoL-M) questionnaire. Multivariable regression analyses were adjusted for age and relationship status.

Most cases had distal hypospadias (82.3%). Age did not differ significantly between groups (25.6 ± 3.8 vs 27.0 ± 1.6 years; p = 0.288). IIEF-5 scores were lower in cases (21.8 ± 3.1 vs 24.5 ± 0.7; p = 0.002), though both groups remained within ranges consistent with absent or mild erectile dysfunction. HOPE scores were also lower in cases (48.5 ± 6.1 vs 58.1 ± 2.4; p < 0.001), driven by differences in meatal configuration, skin coverage, and torsion. SQoL-M did not differ significantly. Group status was the sole independent predictor of IIEF-5 and HOPE scores.

In a predominantly distal cohort, men after childhood hypospadias repair showed statistically significant but clinically modest differences in erectile function scores and lower perceived penile appearance compared with healthy controls, with sexual quality of life preserved. These findings should be interpreted in the context of the small sample size and predominance of distal forms and support consideration of psychosexual assessment within transitional urology programmes. Larger multicentre studies are warranted to further clarify long-term outcomes and risk factors.