Diphallia is a rare double malformation of the penis. As a cause, medicine suspects the consumption of fertility-damaging substances in early pregnancy. In the current state of medicine, diphallia together with all accompanying anomalies can usually be corrected surgically.
What is diphallia?
Diphallia is an extremely rare malformation of the penis. The name comes from the Greek and can be literally translated as “double penis”. The incidence of this phenomenon is described as a ratio of about one case in five to six million. The double penis was first documented in the 17th century in Bologna. Since then, a total of about 100 cases have been described. Often in diphallia, both penises have at least limited function. Bifurcation is to be distinguished from this phenomenon. Also in this phenomenon there is a bifurcation of the penis. Unlike diphallia, the bifurcation is not congenital, but is due to a surgical intervention as part of a ritual act. Diphallia is counted among the embryopathies and thus belongs to the developmental disorders of the early embryonic phase. Like the penis in men, a double malformation can also affect the clitoris in women. However, this phenomenon is also extremely rare.
Causes
Considering its extremely low incidence, the phenomenon of diphallia has not been conclusively studied. So far, it is only possible to speculate about the causes. Currently, medical science assumes the causative factor to be the consumption of fertility-damaging substances in early pregnancy. On average, on the 24th day of pregnancy, the urogenital sinus, rectum and sex cusp separate from each other in the posterior mesoderm of the embryo. The urogenital sinus is the fetal precursor of the urinary and genital tracts. After its separation from the rectum and sex cusps, the penis is formed in the male embryo. Medical science assumes that harmful influences at this early stage impair the function of the homeobox genes. These genes code for the homeodomain. Mutation of the genes can therefore produce supernumerary limbs. For the paired penis specifically, fusion of these genes is thought to be impeded during chromosomal translation.
Symptoms, complaints, and signs
In diphallia, the penis is duplicated. The individual anlagen sometimes lie on top of each other. However, they can also be present right next to each other or at some distance from each other. Usually, both anlagen function, so that at least urine can be passed through one as well as the other. The double malformation does not have to extend over the entire length of the penis. Often, for example, only the glans is affected. Usually, one of the two anlagen is more developed than the other. In most cases, the diphallia is accompanied by other malformations of the genitals or rectum. One of the most common is a cleft scrotum. Developmental disorders of the urethra are also a frequent accompaniment. In most cases, the fertility of affected individuals is at least limited or there is complete infertility.
Diagnosis and course
The diagnosis of diphallia can be made immediately after the patient is born. A diagnosis before birth may also be conceivable. The double anlage of the penis can take a more or less serious course, especially on the psychological level. The degree of suffering for a patient with diphallia strongly depends on the time of diagnosis, the possibility of therapy, the accompanying malformations and additionally the personality of the affected person. As a rule, the malformations of the genital tract can be corrected today. However, infertility may persist.
Complications
Diphallia results in the formation of two penises, which may be associated with various complications. Usually, only the glans is affected by the double formation. First and foremost, patients suffer from psychological discomfort due to the appearance. This can lead to depression or inferiority complexes. Sexual desire is also severely limited. Diphallia is considered bizarre by many people and can lead to problems with partners as a result. Most often, the disease also causes discomfort in the urethra, so that urination is associated with pain.Often, affected individuals are infertile or fertility is very limited. Treatment of diphallia is usually possible by means of surgery. However, this is very complex and is only performed if it is desired by the patient. Diphallia does not have to be corrected in every case. However, most often the treatment is performed because the patients are ashamed of the disease. It is mainly performed before the patient reaches the age of majority, so that there are no psychological problems in adulthood. No further complications occur after the procedure.
When should you go to the doctor?
If diphallia is still present in adulthood and is perceived as a problem by the affected person, a visit to the doctor is recommended. In a discussion with the medical professional, the possible treatment steps can be worked out. In most cases, it is possible to treat the malformation surgically. Such an operation is particularly suitable for people who suffer from diphallia – whether in the form of problems with urination or psychological complaints. Therapeutic counseling can help to reduce the suffering of the affected person. Diagnosis of diphallia does not require a visit to the doctor. The malformation is usually diagnosed by the doctor or the parents directly after birth or even before. Nevertheless, further medical clarification is necessary in order to exclude possible damage to the internal organs. Usually, these measures are taken on the spot in the hospital. In the course of this, the parents are usually offered a consultation with the medical professional, in which they are informed about the risks of diphallia.
Treatment and therapy
Most malformations can be surgically corrected today. This is also true for the double malformation of the penis. In fact, with regard to diphallia, surgery is the only treatment option. However, surgery on the double penis is relatively costly and complex, as the urinary tract may need to be rearranged so that one of the double structures can be removed. The procedure is preceded by an extensive assessment of the patient. The main purpose of this examination is to elucidate the question of additional abnormalities. A surgical intervention option exists for virtually all anomalies associated with diphallia. However, diphallia does not necessarily have to be surgically corrected if the patient does not wish it. Cases are known from the present time in which the affected person has consciously decided against therapy and has mastered his life with the double genital. Nevertheless, an untreated double penis can cause sufferers to feel strong insecurity, self-doubt and shame from their teenage years onwards. Most parents want to spare their offspring ridicule and mortification, and therefore opt for corrective surgery well before their offspring reaches adulthood.
Outlook and prognosis
With modern medical options, it is possible to correct the double deformity in the majority of cases. Without surgical intervention, the patient has to live his life with the diphallia, because there is no alternative possibility of change. Basically, due to medical expertise, the prognosis for diphallia is good. In a corrective surgery the double formation of the penis is corrected. Nevertheless, due to the individual initial situation of the patient, various sequelae and problems may occur. Most of the complaints include infertility or lack of stiffness of the penis. In the case of a shrunken testicle, there is an uncorrectable and thus lifelong infertility of the man. In the case of erectile dysfunction, sexual behavior is permanently disturbed. The surgical procedure causes scars to form in the intimate area. These can lead to discomfort and, in the worst case, to long-term pain. Laser irradiation is necessary in order to alleviate the discomfort. In addition, the correction of diphallia can lead to a shortened penis or undesirable deformities. Conflicts in partnership or unwanted aloneness often occur. Shame, lowered self-esteem, and teasing occur. This triggers psychological problems or illnesses that lead to a severe reduction in quality of life. In severe cases, depression, personality, anxiety or sexual disorders occur.
Prevention
If medical science is correct in its current speculation about the cause of diphallia, the phenomenon can be prevented. If fertility-damaging substances are responsible for the anomaly, the complete abstention from alcohol, drugs, cigarettes, coffee and black tea during early pregnancy can already be understood as a preventive measure.
Aftercare
In most cases, no special measures of aftercare are necessary or required for diphallia. In this case, the disease itself must be treated by medical intervention to prevent further complications in the child’s life. After this intervention, no further measures are usually necessary to alleviate the symptoms. Complications also usually do not occur again. The treatment itself is a surgical procedure. It should be performed at a very early stage, since only early detection and treatment of diphallia can prevent further symptoms. After the operation, the patient must always rest and remain on bed rest. The body should be spared, refraining from exertion or other stressful or athletic activities. In most cases, the affected person is also dependent on psychological support. Especially at a later age, intensive discussions with parents or friends are useful to prevent psychological upsets or even depression. Contact with other patients with diphallia can also be useful. The patient’s life expectancy remains unchanged by this disease.
This is what you can do yourself
Diphallia, as a rare disease, leads to physical discomfort in some of the affected people, which manifests itself, for example, in difficulty in urination. To reduce existing suffering, regular contact with the relevant specialists is the most important measure for the patient. With the help of medication, certain difficulties, such as urination, can be reduced. This also applies to any pain that may occur. In more severe cases, surgical interventions can be considered to completely or partially correct the diphallia. More serious than the physical problems, however, are often the psychological consequences for those affected by diphallia. This is because the condition is usually associated with shame, especially in adults. It is true that diphallia is not recognizable to outsiders, so it is possible to keep the disease a secret from other people. Problems therefore usually only arise for patients when they want to enter into a partnership and fear a negative reaction from their partner. In order to strengthen self-confidence, psychotherapies or participation in self-help groups help some of those affected. If patients feel that the impairment caused by their sense of shame is too strong, surgical interventions may also be considered for psychological reasons. Therefore, surgery for the condition is recommended as early as childhood.
