Epispadias

An epispadias is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. An epispadias is an uncommon and partial form of a spectrum of failures of abdominal and pelvic fusion in the first months of embryogenesis. Most cases involve more severe defects, including a small and bifid phallus with bladder exstrophy or even cloacal exstrophy involving the entire perineum.

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Despite the similarity of name, an epispadias is not a type of hypospadias, and involves a problem with a different set of embryologic processes. The cause of this defect of early embryogenesis is unknown but does not involve androgens.

Women can also have this type of congenital malformation. Epispadias of the female may occur when the urethra develops too far anteriorly, exiting in the clitoris or even more forward. For females, this may not cause difficulty in urination but may cause problems with sexual satisfaction. Frequently, the clitoris is bifurcated at the site of urethral exit, and therefore clitoral sensation is less intense during sexual intercourse due to frequent stimulation during urination. However, with proper stimulation, using either manual or positional techniques, clitoral orgasm is definitely possible and quite pleasurable.