Brief overview
- Causes and risk factors: Congenital malformation with a cause not yet fully understood; possible disturbance of embryo development by drugs, nicotine, or alcohol.
- Symptoms: Completely or partially double penis. In some cases both function completely, in others only one. Often problems with urination, other malformations are possible, mostly infertility.
- Diagnosis: Visual diagnosis immediately after birth, further examination for other malformations such as heart defects including ultrasound and possibly magnetic resonance imaging
- Treatment: As a rule, doctors operate on diphallia. In doing so, they correct as many malformations as possible at the same time.
- Prognosis: If left untreated, psychological problems are possible, scars may remain after the operation, erectile dysfunction after the operation is possible.
- Prevention: avoid alcohol, nicotine, other drugs and certain medications during pregnancy if possible
What is diphallia?
Scientists assume that defects in the embryonic development of the child cause diphallia. Therefore, double penis belongs to the so-called embryopathies. In diphallia, either the whole penis is doubled or only a part of it (such as the glans). The division is either mirror-image (symmetrical) or unequal (asymmetrical). In this case, the two penises lie next to or on top of each other. It is also possible for the two to be significantly different in shape and size. Diphallia is divided into three groups:
- Diphallus glandularis = only the glans penis is double
- Diphallus bifidus = bipartite penis (corpus cavernosum divided)
- complete diphallia/double penis = complete doubling of the male member
Based on this classification, a classification was introduced which is still valid today. In this classification, the diphallias are differentiated into two main groups, each of which is further subdivided.
|
Main group |
Subgroup |
Explanation |
|
true diphallia |
complete diphallia |
Affected persons have two penises with three corpora cavernosa each |
|
partial diphallia |
One penis is correctly formed, the other is smaller or completely atrophied |
|
|
Phallus bifidus |
The penile shaft is divided up to its exit, but each limb has only one corpus cavernosum |
|
|
partial phallus bifidus |
cleavage affects only a part of the penis, for example the glans penis |
Diphallia occurs in about one in 5.5 million births, so it is very rare. It was first described in 1609 in Bologna, Italy. Since then, doctors have recorded about 100 cases of double penis. Affected individuals often suffer from other malformations, such as a double kidney or shrunken testicles.
In addition to diphallia in males, comparable disease symptoms have been described in females. The doubling here affects the clitoris. It is accompanied, for example, by doubled labia minora.
Diphallia: symptoms
The symptoms of diphallia differ from case to case. In most cases, at least one penis functions normally. The atrophied penis of a partial diphallia, on the other hand, is not usable. In so-called true complete diphallia, both limbs may be aroused to the point of ejaculation.
In addition, problems with urination have often been observed with diphallia. Urine usually dribbles uncontrollably from the underdeveloped penis (incontinence). In addition, the urine stream sometimes seems weaker than usual. Furthermore, many affected individuals are infertile or have limited fertility.
In addition, affected individuals often have other malformations (malformations) that have been observed along with diphallus. Researchers have found that these malformations are far more common with true diphallus than with phallus bifidus. For example, these include:
- Defects in the rectum (anorectal malformations), such as connecting ducts between the bowel and bladder (fistulas) or narrowing of the anus
- Incorrect position of the urethral orifice (hypo-/epispadias), supernumerary urethra
- Urinary bladder open to the outside (bladder exstrophy)
- Gaping pubic bones
- Defects of skeletal or cardiac muscles
- Spinal deformities, including spina bifida, in which the spinal cord may be exposed
- Duplication of the colon, urinary bladder or kidneys, some of which are located elsewhere (such as in the pelvis)
- Shrunken testicles, testicular malformations
The causes of diphallia are not fully understood due to its rare occurrence. Researchers assume that errors in embryonic development lead to a double penis. The embryonic phase begins in the second and ends around the tenth week of pregnancy.
During this time, the child’s organs are formed. They are formed from the first cell layers of the embryo, the three contiguous so-called cotyledons (entoderm and ectoderm with the intervening mesoderm). At the ends, the ento- lies directly on the ectoderm. The lower part is called the cloacal membrane. This is where the intestinal outlet and the urinary and sexual organs are later formed. Defects in these cell assemblies lay the foundation for diphallia.
Embryonic connective tissue cells accumulate around the cloacal membrane from the fourth week. Genital humps, folds and bulges develop. The penis (or clitoris) normally grows from the genital bump. The genital folds later form the erectile tissue. And the testicles develop from the genital bulges. Here, too, errors may lead to diphallia.
Risk factors Alcohol, nicotine, drugs and some medications.
These developmental stages are particularly susceptible to harmful substances such as alcohol, nicotine, other drugs and some medications. For example, they prevent the correct separation of the individual cell assemblies or damage the genetic material in the cells. With the adjacent location of the embryonic structures, scientists also try to explain why several malformations occur together in diphallia.
A connection between diphallia and genetic diseases in the family of the affected person has been discussed, but has not yet been proven. In addition, diphallus has not been inherited to date – especially because affected individuals are usually infertile.
Diphallus: diagnosis and examination
If diphallia is diagnosed, the doctor searches the body for other malformations. He checks unnatural connecting ducts with a probe and ultrasound. He uses a stethoscope to listen to the heart for defects. An ultrasound device helps to examine the internal organs.
For example, the doctor can detect duplicate or incorrectly positioned kidneys. Finally, ultrasound (sonography) plays a decisive role when doctors plan the surgical procedure for diphallia. This is because it is also used to visualize the individual corpora cavernosa of the double penis. In the case of larger malformations, the doctor arranges for magnetic resonance imaging (MRI). The images produced allow a good assessment of soft tissues in particular.
Treatment
Doctors treat diphallia or phallus bifidus with surgery. Other malformations are also usually corrected by surgeons. They always try to treat as many defects as possible at once and thus restore the natural normal state.
Doctors proceed differently depending on the type of double penis. In the case of a phallus bifidus (divided erectile tissue), the surgeons try to bring the split penis together. It may be necessary to recreate the urinary draining structures (especially urethra). In the case of a true diphallia (two independent penises), the excess penis is separated.
The operation in case of a complete phallus bifidus or a complete diphallia (splitting or doubling up to the pelvis) is usually a bit more complicated. This is because the double penis in these cases is usually attached to the pubic bone, which makes amputation more difficult (higher risk of complications).
In all cases, the wish of the patient or his guardian (usually the parents) is decisive for the choice of diphallia treatment. Although surgery is the only treatment for a double penis, not all associated malformations need to be treated. For example, a single kidney is sufficient to sufficiently detoxify and drain the body. Smaller heart defects are also not operated on.
Course of the disease and prognosis
The treatment measures may lead to a shorter member, scars and deformation of the penis. In most cases, those affected suffer from severe psychological stress later on.
Especially during puberty, an already emotionally difficult developmental phase, patients with diphallia are insecure and shy. Shame and feelings of inferiority dominate the emotional state. These feelings are especially pronounced if the double penis has not been treated.
Preventing diphallia
According to current research, doctors make the following recommendations:
- Do not take harmful substances, especially during pregnancy. Refrain from alcohol, cigarettes and other drugs.
- If you are taking medication and plan to become pregnant, always consult a doctor beforehand regarding possible side effects. He or she will adjust or change the medication accordingly.
- It is best to have your child treated as early as possible. In this way, you can spare the affected person the psychological consequences of diphallia.
