It is biologically possible for a male to be born with two penises, a rare congenital condition. While striking in its appearance, understanding this phenomenon requires a look into the biological processes that govern early development. This article explores how this condition arises, its common associations, and medical management.
What is Diphallia?
The medical term for being born with two penises is diphallia, also known as penile duplication. It is classified under the ICD-10 code Q55.6. Diphallia is an extremely rare developmental abnormality, occurring in about 1 in 5.5 million live male births, with only around 100 cases reported since 1609.
The presentation of diphallia can vary significantly among individuals. It ranges from a partial duplication, such as a double glans, to complete duplication where two full penises are present. In some cases, both penises may be similar in size, while in others, one might be larger or more developed than the other. The duplication can involve varying degrees of the internal structures, including the urethra and erectile tissues.
How Diphallia Develops
Diphallia arises from disruptions during early embryonic development, specifically between the third and sixth weeks of gestation, a crucial period for genitourinary system formation. The exact causes are not fully understood, but the condition is thought to result from abnormalities in the cloacal membrane and the genital tubercle.
The cloacal membrane is a temporary embryonic structure. Normally, mesenchyme migrates around this membrane to form a single genital tubercle, which develops into the penis. If the cloacal membrane is duplicated or improperly formed, the mesenchyme can migrate around both structures, leading to the formation of two distinct genital tubercles.
This abnormal division or cleavage of the genital tubercle during its development is believed to be the primary mechanism behind penile duplication. While genetic factors and environmental influences such as chemical stress or infections have been suggested, there is no single, simple explanation for its cause. The precise timing and nature of the disruption dictate the extent of the duplication, from a bifid glans to two complete penises.
Commonly Associated Health Issues
Individuals with diphallia often have other congenital anomalies affecting multiple bodily systems due to shared embryonic origins. The presence and severity of these associated conditions vary widely and can pose more serious health challenges than the penile duplication itself.
The urinary system is frequently affected, with common anomalies including duplicated bladders, abnormal urethras (such as hypospadias or epispadias), and kidney abnormalities. Gastrointestinal issues are common, including imperforate anus, duplicated colons, and other bowel malformations. Skeletal system anomalies, such as spinal defects and pubic symphysis diastasis, are also observed.
These associations occur because the structures of the genitourinary, gastrointestinal, and skeletal systems develop from closely related embryonic tissues. Infants with these complex associated conditions may face a higher risk of complications, including infections.
Medical Approach to Diphallia
Diagnosis of diphallia usually occurs at birth through physical observation. Subsequent diagnostic methods involve imaging techniques to assess the extent of duplication and identify internal anomalies. Ultrasound and magnetic resonance imaging (MRI) are commonly used to visualize the number of corpora cavernosa, urethras, and to check for associated abnormalities in the urinary and gastrointestinal tracts.
Treatment for diphallia is highly individualized, depending on the specific anatomy and the presence of associated health issues. Surgical intervention is often necessary to address functional concerns, such as ensuring proper urinary flow and bowel function. In some instances, one of the duplicated penises may be removed, especially if it is underdeveloped or non-functional, with efforts made to preserve the most functional structure.
A multidisciplinary medical team, including urologists, pediatric surgeons, and gastroenterologists, is typically involved in providing comprehensive care. The goal of treatment is to achieve satisfactory functional and cosmetic outcomes, allowing individuals to lead healthy lives. While complex, appropriate medical management helps many individuals navigate the challenges associated with this rare condition.