Diphallia

Diphallia: description

The diphallia is a very rare, congenital penile malformation in which sufferers have a double penis. The term comes from the Greek (di- = two-fold, phallos = penis). Normally, the male member consists of three cavernous bodies. Two are at the top and are called corpora cavernosa. Underneath lies the erectile corpus spongiosum, in the middle of which runs the urethra. From him finally the glans (glans penis) comes out.

Scientists believe that errors in the child’s embryonic development cause a diphalia. Therefore, the double penis is one of the so-called embryopathies. In the case of the diphallia, either the whole penis is doubled or only part of it (eg the glans). The division can be either mirror image (symmetric) or unequal (asymmetric). The two penises can be next to or on top of each other. In addition, both can differ significantly in shape and size from each other. The diphallia is divided into three groups according to Schneider:

• Diphallus glandularis = only the penile quill is double
• Diphallus bifidus = bipartite penis (erectile tissue divided)
• complete diphallia / double penis = complete doubling of the male member

Following this classification, a classification was introduced that is still valid today. The diphallia are split into two main groups, which are each subdivided once again.

The 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. Sufferers often also suffer from other malformations, such as a double kidney or shrinking testicles. In addition to the diphallia in men, comparable symptoms in women were described. The duplication concerns the clitoris here. It is accompanied, for example, by doubled labia minora.

Diphallia: symptoms

The complaints of a diphallia differ from case to case. In most cases, at least one penis works as usual. The stunted penis of a partial diphallia, however, is useless. In a true complete diphalia, both members may be excited to ejaculation. The same applies to a phallus bifidus. Therefore, in some cases, a pure diphallia is more of a cosmetic than a functional problem. However, especially with increasing age often psychological problems are added (feeling of inferiority, shame, self-doubt, etc.).

In addition, problems with urination were frequently observed in a diphalia. Urine usually drips uncontrollably from the underdeveloped penis (incontinence). In addition, the urine stream sometimes seems weaker than usual. Furthermore, many sufferers are infertile (or limited fertile). In addition, patients may suffer from other malformations (malformations) seen with a diphallus. Researchers have found that these malformations are much more common in a true diphalia than in a phallus bifidus. These include, for example:

• Defects in the rectum (anorectal malformations), eg. B. connecting ducts between the intestine and bladder (fistulas) or a narrowing of the anus
• Wrong position of the urethra mouth (hypo / epispadia), supernumerary urethra
• Outward open bladder (bladder ecstrophy)
• Gap-breaking pubes
• Defects of skeletal or cardiac muscles
• Spinal malformations, including spina bifida, where the spinal cord may be exposed
• Doubling of the large intestine, urinary bladder or kidneys, some of which are elsewhere (eg in the pelvis)
• Shrunken testicles, testicular shifts

Diphallia: causes and risk factors

The causes of a diphallia are not fully understood due to the rare occurrence. Researchers believe that errors in embryonic development lead to a double penis. The embryonic phase begins in the second and ends at about the tenth week of pregnancy. During this time, the child’s organs form. They arise from the three adjacent cotyledons: Ento and Ectoderm with the Mesoderm in between. At the ends, the entorod lies directly on the ectoderm. The lower part is called Kloakenmembran. Here later, the intestinal outlet and the urinary and genital organs are formed. Defects in these cell clusters lay the foundation for a diphallia.

Embryonic connective tissue cells accumulate around the cloacal membrane as of the fourth week. Genital bumps, creases and wrinkles are created. From the genital hump usually grows the penis (or the clitoris). The genital folds later form the erectile tissue. And testicles arise from the genital ridges. Again, errors can lead to a diphalia. The cloaca divides itself by a einwachsende fibreboard (septum urorectale) into a so-called urogenital sinus and an anorectic canal. This eventually results in further parts of the urinary and genital apparatus as well as the rectum.

Risk factors alcohol, nicotine, drugs and some medications

These developmental phases are particularly vulnerable to harmful substances such as alcohol, nicotine, other drugs and some medications. For example, they prevent the correct separation of the individual cell groups 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 a diphallia.

A connection between the diphallia and genetic diseases in the affected person’s family has been discussed, but has not yet been demonstrated. In addition, the diphallus has not been inherited until today.

Diphallia: diagnosis and examination

A diphalia is usually detected immediately after birth. It is a so-called eye diagnosis, because you can see the Doppelpenis already with the naked eye. The doctor may ask for medications or harmful substances that may have been taken during delivery and may have caused the dipiphallia. There are also cases in which patients did not go to the doctor until adulthood. Here, the doctor will ask the person directly about possible problems with urination or sexual intercourse.

If a diphallia is diagnosed, the doctor will search the body for further malformations. Unnatural passageways, he checks with a probe and ultrasound. With the stethoscope he may be able to hear possible heart defects. An ultrasound device also helps with the examination of the internal organs. For example, duplicate or misplaced kidneys can be detected this way. Ultimately, ultrasound (sonography) also plays a crucial role when physicians plan the surgical procedure for a diphalia. For with his help, the individual cavernous bodies of Doppelpenis are represented. For larger malformations, the doctor initiates a magnetic resonance imaging (MRI). On the basis of the generated images, especially soft tissue can be assessed well.

Diphallia: treatment

The diphallia or the phallus bifidus are treated surgically. Other malformations are usually corrected by surgeons. It is always trying to treat as many defects at once and restore the natural state. After the procedure, the patient should be able to control the urination completely. In addition, the surgeons use extreme care in every operation so as not to hurt nerves. After all, the preservation of the erection is one of the main objectives of the usually quite complex Diphallie treatment.

The doctors proceed differently depending on the type of double penis. In a phallus bifidus, the surgeons try to unite the split penis. Under certain circumstances, the urinary drainage structures (especially the urethra) have to be newly created. In a true diphalia (two independent penises) the surplus penis is severed. The intervention in a complete phallus bifidus or a complete diphallia (splitting or doubling up to the pelvis) is usually a bit more complicated. As a rule, the double penis is attached to the pubis in these cases, which makes amputation difficult (higher risk of complications).

In all cases, the desire of the patient or his guardian (parent) is crucial for the choice of the diphallia treatment. Although surgery is the only treatment for a double penis, it does not need to treat all associated malformations. For example, a single kidney is enough to detoxify and drain the body. Even minor heart defects are not operated on.

Diphallia: Disease course and prognosis

The disease outlook for a diphalia is usually closely related to the success of the operation. In addition to a non-variable infertility (for example, by shrinking testes), the penis may not be stiff (erectile dysfunction). The treatments may also result in a shorter limb, scarring and deformities of the penis. Most sufferers suffer later from strong mental stress. Especially in puberty, an emotionally difficult stage of development anyway, patients with diphallia are insecure and shy. Shame and feelings of inferiority dominate the emotional state. These sensations are especially pronounced when the double penis has not been treated.

Prevent diphallia

The following recommendations can currently be made: Do not take any harmful substances, especially during pregnancy! Avoid alcohol, cigarettes and other drugs! If you are taking medications and planning to become pregnant, you should always consult a doctor for possible side effects. This person can adapt and change the medication accordingly. And let your child treat as early as possible! In this way they can give him the subsequent psychic burden of one Diphallia spare!