Aphallia

What is aphallia?

Aphallia, which means “absent penis,” is a rare congenital condition (one that’s present from birth) where the penis fails to develop during embryonic growth. Further, the urethral opening (urinary outlet) isn’t located in the typical place. It’s often in the perineal area (the space between your anus and genitals).

Another name for aphallia is penile agenesis.

Some researchers believe that “aphallia” should be used to describe the situation when a baby is born without corporal tissue — the spongy tissue that fills with blood during sexual excitement. The penis and clitoris both contain this type of tissue. Using this definition, the term “aphallia” describes a condition that happens to infants who otherwise are genetically male or female, XY or XX sexual chromosomes, respectively.

How common is aphallia?

Aphallia is a rare condition. It happens in 1 in 10 million to 30 million births, according to one estimate. The condition is found most often in babies assigned male at birth (XY sexual chromosomes).

What is the difference between buried penis and aphallia?

In some cases, the penis may be there but isn’t visible. To diagnose aphallia, a healthcare provider may have to exclude other conditions first, including:

• Buried penis: In this condition, your penis is a normal size but hidden under the skin of your abdomen, thigh or scrotum (the sac that holds your testicles). It’s also known as concealed penis or hidden penis.
• Hypospadias: In this condition, the urethra (the tube that transports urine from your bladder to your urinary meatus) doesn’t form correctly, and the meatus (the hole where pee leaves your body) isn’t in the typical spot at the tip of your penis. The meatus might be on the shaft of your penis or on your scrotum.
• Micropenis: In this condition, your penis is shorter than 1.9 centimeters (0.75 inches) when the child is born.
• Differences of sex development: In this condition, sexual development is atypical due to genetic, anatomical or hormonal causes. Genitals may be ambiguous (not typically male or female) and/or they don’t match the chromosomal sex.

What are the symptoms of aphallia?

The symptoms of aphallia include:

• Not having a penis, but having a scrotum and testicles.
• Having results from a karyotype test that’s normally aligned with a child assigned male at birth (46, XY) or assigned female at birth (46, XX).

A provider can diagnose this condition prenatally (before birth).

What causes aphallia?

The cause of aphallia is unknown. However, researchers do know fetal development (the growth of the fertilized egg) doesn’t happen in a typical way (agenesis).

How is aphallia diagnosed?

Providers can diagnose aphallia during a physical examination. But they may order blood tests or imaging tests to confirm the diagnosis.

How is aphallia treated?

When a provider suspects aphallia in a newborn child, the first step is to look for other congenital malformations that may threaten the child’s life.

The next priority is to make sure the baby is able to urinate (that pee can leave their body through a hole). Sometimes, a vesicostomy is required to create a way for urine to leave their body if an obstruction exists.

During the first years of life, your child may have surgery to create a penis (phalloplasty) and a urethra (urethroplasty). A specialized surgeon will help decide the best method for these procedures.

Traditionally, providers have assigned female sex, or gender, to infants with aphallia even though the infants had testes. The traditional treatment has been to perform feminizing surgery (feminizing genitoplasty). In many cases, as the children grew older, the sex/gender that providers assigned at birth didn’t match their authentic gender identity.

Many healthcare providers now believe that working toward a phalloplasty (creating a penis) is a better solution for a genetically male child until the child is old enough to be confident in their sex and make their own decisions on how to go forward. After puberty, surgeons can perform a second phalloplasty to provide an adult-sized penis. Erectile function isn’t expected.

How can I reduce the risk of giving birth to an infant with aphallia?

Because the cause of aphallia is unknown, there’s no way to prevent it. During genetic counseling, you can discuss genetic conditions and prenatal diagnosis. This can help inform and prepare parents before conception and/or birth.

General recommendations of a healthy lifestyle will always benefit a person who is and their fetus.

What can I expect if my child has aphallia?

If your child has aphallia without any other complications, the prognosis is good. The outlook becomes a little worse if there are additional medical issues. Some of the complications can be very serious. These may include breathing difficulties and missing certain organs necessary for life.

How do I take care of myself as the parent of a child with aphallia?

It’s normal to feel like you have to make many big decisions when your child is born, but this isn’t necessary. It’s important to take one step at a time. Your child will go through many physical, emotional and intellectual changes growing up. In order to be in the best condition to handle these changes, parents and families can benefit from counseling.

It’s preferable that parents have a close relationship with their child’s healthcare team. The providers will set expectations for the parent or parents. You should feel free to contact the providers with any questions or concerns.

What questions should I ask my provider?

You may want to ask your provider questions like:

• How should I talk about this with my child?
• Where can I get information about sex and gender identity?
• How should I talk about aphallia with our family and friends?
• How do I make decisions about medical care?
• Where can I find a support group?

What happens when an adult has aphallia?

Healthcare providers have diagnosed fewer than 100 people in the world with aphallia. Many of these people aren’t yet adults. Treating aphallia in an adult presents more difficulty than treating it in a child.

A note from Cleveland Clinic

Hearing that your child has a congenital condition (one they’re born with) that makes them in any way different from the child you expected is a difficult thing for a parent. You’re not alone in feeling scared, upset, worried or even angry. It’s important to take the time you need to make decisions for your child’s welfare and to deal with the most serious decisions first. Take the opportunity to talk with your healthcare team to get suggestions on how to proceed.