Dear Dr. Roach: I am a 78-year-old man. Yesterday, I read that I am considered intersex because urine does not come out the end of my penis, but rather under the penis shaft. This does not surprise me much, but I am really curious about it. I want to see a psychiatrist just to talk about it. What do you think? — Anon.
Answer: Hypospadias is a common condition where the urethral meatus (the opening where urine comes out) is on the underside of the penis. About one male per 200 has this condition.
There are many, many DSDs, or differences in sex development (the term “intersex” is no longer used in medical literature, but some people with DSDs choose to describe themselves that way), which are conditions people are born with in the genitourinary system and reproductive systems that sometimes affect sex determination and differentiation. The terms used in this field are changing, as is the understanding of the complex biology. It is not as simple as many think — that a person’s chromosomes determine their sex.
Some of those born with hypospadias have other conditions that are commonly thought of in the large group of DSDs, but most cases do not have other differences in their genitourinary and reproductive anatomy. A common, and usually relatively minor, difference in sex development does not have to change your identity.
I am in favor of talking to a psychiatrist, therapist or other mental health professional to discuss your concerns. Questions about the function of the penis, whether urination or sexual, should be presented to a urologist.
