[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Lower urinary tract and male genital system](https://durgical.com/en/general-pathology/areas/urinary-male/) › The penis: hypospadias, epispadias, phimosis and balanoposthitis

# The penis: hypospadias, epispadias, phimosis and balanoposthitis

- Lesion

The urethral opening may be misplaced, the foreskin too tight, and poor hygiene lets infection inflame the glans and prepuce.

Updated Nov 12, 2026

## Key points

- Hypospadias: ventral opening, failure of urethral fold fusion; with cryptorchidism and hernia; risk of infertility.
- Epispadias: dorsal opening, linked to bladder exstrophy.
- Phimosis: predisposes to balanoposthitis, smegma accumulation and penile squamous cell carcinoma.
- Paraphimosis: retracted tight foreskin constricts the glans; an emergency.
- Genital ulcers: painless and indurated (syphilis), painful vesicles (herpes), painful ragged (chancroid), beefy red painless (granuloma inguinale).

## What it is

Hypospadias is the commonest congenital anomaly of the penis: the urethra opens on the ventral surface because the urethral folds fail to fuse; it often comes with undescended testes and inguinal hernia. Epispadias opens dorsally and accompanies bladder exstrophy. Phimosis is a foreskin too tight to retract, congenital or after repeated inflammation; forcing it back can trap the glans (paraphimosis). Balanoposthitis is infection of the glans and prepuce by Candida, anaerobes, Gardnerella or pyogenic bacteria. Sexually transmitted infections (syphilis, herpes, chancroid, granuloma inguinale) produce ulcers.

## Structure

- Balanoposthitis: nonspecific acute and chronic inflammation of the glans and inner foreskin.
- Chronic inflammation leads to scarring of the prepuce and phimosis.
- Lichen sclerosus (balanitis xerotica obliterans) is a sclerosing lesion that causes phimosis and is linked to HPV-independent carcinoma.

## Clinical notes

- Hypospadias with bilateral undescended testes requires evaluation for disorders of sex development.
- Good hygiene and treatment of phimosis lower the risk of infection and cancer.

## Memory aid

Hypo is under, epi is on top; a tight hood traps smegma and heat.

## Test yourself

Think of the answer, then tap the question to see it.

## On which surface does the urethra open in hypospadias?

On the ventral (under) surface of the penis.

## Which anomaly accompanies epispadias?

Bladder exstrophy.

## Why does phimosis matter beyond discomfort?

It favours repeated balanoposthitis and is a risk factor for penile squamous cell carcinoma.

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## Elsewhere in DurgiPedia

- [Hypospadias and epispadias](https://durgical.com/en/embryology/hypospadias-and-epispadias/)

## Connections

## Related 3

- [Penile tumours](https://durgical.com/en/general-pathology/penile-tumours/)
- [Cryptorchidism, testicular atrophy and reduced fertility](https://durgical.com/en/general-pathology/cryptorchidism-testicular-atrophy-and-reduced-fertility/)
- [Diseases of the urethra](https://durgical.com/en/general-pathology/diseases-of-the-urethra/)

## Related conditions 7

- [Hypospadias](https://durgical.com/en/conditions/hypospadias/)
- [Phimosis](https://durgical.com/en/conditions/phimosis/)
- [Syphilis](https://durgical.com/en/conditions/syphilis/)
- [Genital herpes (herpes simplex infection)](https://durgical.com/en/conditions/genital-herpes/)
- [Chancroid](https://durgical.com/en/conditions/chancroid/)
- [Granuloma inguinale (donovanosis)](https://durgical.com/en/conditions/granuloma-inguinale/)
- [Cryptorchidism (undescended testis)](https://durgical.com/en/conditions/cryptorchidism/)

## Microorganisms 4

- [Candida albicans](https://durgical.com/en/microbiology/candida-albicans/)
- [Treponema pallidum](https://durgical.com/en/microbiology/treponema-pallidum/)
- [Herpes simplex virus 2](https://durgical.com/en/microbiology/herpes-simplex-virus-2/)
- [Haemophilus ducreyi](https://durgical.com/en/microbiology/haemophilus-ducreyi/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Hypospadias Urogenital Reconstruction](https://www.ncbi.nlm.nih.gov/books/NBK564407/) (StatPearls (NCBI Bookshelf), 2024); [Phimosis](https://www.ncbi.nlm.nih.gov/books/NBK525972/) (StatPearls (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/the-penis-hypospadias-epispadias-phimosis-and-balanoposthitis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/the-penis-hypospadias-epispadias-phimosis-and-balanoposthitis/