Penis Problems 3: Urethras

[WARNING: this article contains photographs of penes (penises).]

I have no medical training whatsoever. I am writing this article as I personally have a urethral condition. If in any doubt - especially if you are in pain, sore or have any bleeding - please do not be embarrassed and seek qualified medical attention.

I have quoted and cited various articles. I have attempted to go from the simple to the more complex. Whilst seeking advice and information can be reassuring, it can also induce fear. This article is no substitute for qualified medical advice. The blog-post is a pointer only.

The urethra has an opening known as a urethral/urinary meatus/orifice - it is a thin slit with tiny lip-like sides (or labia) found at the end of the glans, the head of the penis. The urethral orifice may also appear slightly rounded, which is perfectly normal, especially so where the penis has been circumcised. The image below is of a healthy penis with a normal urethral slit.

[Image description: glans courtesy Wikipedia]

There are three main fairly common malformations:

If the urethra is on the underside of one’s penis the condition is known as hypospadias.

If the urethra is on the upper side of one’s penis the condition is known as epispadias.

If the urethra is misshapen it may lead to a condition known as meatal stenosis.

However, there are several other possible urethral conditions. The image below highlights a glans with split urethral orifice. The writer has this condition. In my case it can make urination a tad messy: were I to retract my foreskin two separate flows of urine would shoot out in two different directions making it impossible to control.  Growing up I was constantly in trouble for missing the w.c. Thankfully, I was not circumcised, so this means I can use my foreskin to direct urine flow. I have no idea of the anatomical reasons for my personal condition as my parents never had it checked out and I have learned to live with it. “It could be a double or duplicated urethra. It could be a fistula. It could be any number of rare conditions.”

[Image description: glans with split urethral orifice; courtesy & © The Penis.]

The following is an article (redacted by this writer) taken from Mothering.

"The urinary system is both amazing and complex. Urine is formed in the kidneys by their filtering the blood. The kidneys are located in the back, just under the ribs. A tube called a ureter extends from each kidney down to the bladder. As the urine is formed, it flows down these tubes and is stored in the bladder. Urine leaves the bladder and exits the body through a tube called the urethra.

In … boys the urethra is long, and S-curved. The final portion travels the length of the penis, and typically opens at the hole in the tip.

The formation of the male urethra in utero is complex, and not completely understood. This development can go awry in a number of ways, including part or all of the urethra in the wrong location, valves blocking urine flow, or dilatation so that flow isn't blocked when it should be. Some boys even have two urethras.

Urethral duplications occur in many varieties and seem to come from many different abnormalities of development. No widely accepted classification has yet been adopted. Most duplications occur with one urethra on top of the other. Occasionally, however, duplex urethras occur side by side. This is usually the case if a child has two complete penises, but also occurs if the penis is fused but widened. Most of these children have two bladders, plus two normal urethras, and only need surgery if it is needed for cosmetic reasons.

The more common situation of one urethra on top of another occurs in dorsal and ventral varieties.

In dorsal duplications of the urethra, a normal urethra follows the usual channel and ends in a normal hole at the tip of the penis. The other opening appears on the upper surface of the penis, anywhere between the tip and the base. This extra urethra may end in a blind pouch before reaching the bladder. If it does extend the entire length and insert into the bladder, the child will usually dribble urine out of this urethra, since there is no sphincter mechanism to restrain urine flow. Surgery is sometimes needed for incontinence or repeated infections. Since the normally positioned urethra has a normal bladder neck and normal sphincter mechanism, surgery consists of simply excising the extra urethra.

The ventral variety is more variable and less well understood. In some instances, two complete urethras come off the bladder; in others, the urethra bifurcates somewhere along the path. The opening from the second urethra is often located on the underside of the penis (and is thus less visible than in the dorsal variety), but it can appear further down, even as far away as the anterior rim of the anus. The closer the opening is to the anus, the more likely that this abnormally placed urethra is the normal one, with the functioning sphincter mechanism. The normally located penile urethra is often narrow, inelastic, and functions poorly, if at all. As an adult, ejaculation would also occur out of the anal urethra, not necessarily diminishing sexual pleasure, but certainly affecting fertility.

Not all cases of duplex urethras need surgery, or any treatment at all. Perianal urethras should be repaired; the surgery is complicated and usually involves trying to move that urethra forward. If both openings are on the penis, as in your son, surgery is only indicated if there is a problem with incontinence, infections, or reflux (the backward flow of urine). Incontinence or isolated infections are usually present early on if they will be present at all. Reflux can be present early on, but then disappear on its own. It can, however, develop or re-develop at any time, even in adulthood, leading to infections and pressure-related kidney problems. If the two urethras lie right next to each other, the thin wall between them can give way. When the person urinates, this perforated wall can act as a flap-valve to obstruct urine flow, causing pressure back up. When undetected, this pressure can, over years, lead to renal failure, and even to kidney transplant.

For most of us, the medical conditions that afflict us as adults have their roots in childhood. Attention and appropriate medical care can prevent many of these conditions. For your son, close attention is even more important. His situation might cause him no problems (some cases of double urethra are only noticed incidentally, late in life). It could, however, progress to something serious if not followed carefully. Stay in close contact with your pediatrician and/or urologist, so that infections or reflux can be quickly treated.


Alan Greene MD FAAP, July 17, 1996"

Now, some more technical information from Wikipedia:

"Hypospadias is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus (the opening, or male external urethral orifice). Instead of opening at the tip of the glans of the penis, a hypospadic urethra opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum. A distal hypospadias may be suspected even in an uncircumcised boy from an abnormally formed foreskin and downward tilt of the glans.

The urethral meatus opens on the underside of the glans penis in about 50–75% of cases; these are categorized as first degreehypospadias. Second degree (when the urethra opens on the shaft), and third degree (when the urethra opens on the perineum) occur in up to 20 and 30% of cases respectively. The more severe degrees are more likely to be associated with chordee, in which the phallus is incompletely separated from the perineum or is still tethered downwards by connective tissue, or with undescended testes (cryptorchidism).

[Image description: penis with hypospadias 1 and fistulae 2 & 2; courtesy & © Wikipedia]

A much rarer and unrelated type of urethral malformation is an epispadias. This is not a problem of the urethral groove or meatus, but a failure of midline penile fusion much earlier in embryogenesis. An isolated opening of the dorsal ("top") side of the penis is rare, and most of these children have much more severe defects, involving a small and bifid phallus with bladder exstrophy or more severely, cloacal exstrophy involving the entire perineum. The cause of this defect of early embryogenesis is unknown but does not involve androgens. … In most cases, the cause of this birth defect is not fully understood. 

[image description: an erect penis with hypospadias; courtesy & © Wikipedia]

First degree hypospadias are primarily a cosmetic defect and have little effect on function except for direction of the urinary stream. If uncorrected, a second or third degree hypospadias can make male urination messy, necessitate that it be performed sitting, impair delivery of semen into the vagina (possibly creating problems with fertility), or interfere with erections. In developed countries, most hypospadias are surgically repaired in infancy. Surgical repair of first and second degree hypospadias is nearly always successful in one procedure, usually performed in the first year of life by a pædiatric urologist or a plastic surgeon.

When the hypospadias is third degree, or there are associated birth defects such as chordee or cryptorchidism, the best management can be a more complicated decision. A karyotype and endocrine evaluation should be performed to detect intersex conditions or hormone deficiencies. If the penis is small, testosterone or human chorionic gonadotropin injections may be given to enlarge it prior to surgery.

Surgical repair of severe hypospadias may require multiple procedures and mucosal grafting. Preputial skin is often used for grafting and circumcision should be avoided prior to repair. In a minority of patients with severe hypospadias surgery produces unsatisfactory results, such as scarring, curvature, or formation of urethral fistulas, diverticula, or strictures. A fistula is an unwanted opening through the skin along the course of the urethra, and can result in urinary leakage or an abnormal stream. A diverticulum is an "outpocketing" of the lining of the urethra which interferes with urinary flow and may result in post-urination leakage. A stricture is a narrowing of the urethra severe enough to obstruct flow. …

Hypospadias are among the most common birth defects of the male genitalia (second to cryptorchidism), but widely varying incidences have been reported from different countries, from as low as 1 in 4000 to as high as 1 in 125 boys.

The incidence of hypospadias around the world has been increasing in recent decades. In the United States, two surveillance studies reported that the incidence had increased from about 1 in 500 total births (1 in 250 boys) in the 1970s to 1 in 250 total births (1 in 125 boys) in the 1990s. Although a slight worldwide increase in hypospadias was reported in the 1980s, studies in different countries and regions have yielded conflicting results and some registries have reported decreases."

There is information aplenty on the 'net; but the opinion of an experienced professional is more likely to re-assure and/or assist.

A Low for High Tea

My taxi pulled up in front of Manchester's Radisson Blu Edwardian and deposited me in front of the window proudly displaying the Opus One logo. I turned to look for the entrance. No indication as to which way to go to enter. First I hobbled to the right to find a disabled entrance - alas for the office-block next door. I limped back to where I was dropped off and staggered in the opposite direction. Lots of steps. Lots of steps. There must be some step-free access in this day and age, I encouraged myself. At the corner of the building, puffing and panting, I turned and found, tucked away, the ramp to get me inside. Some signage at the front of the edifice would have proved helpful, and I suggested such as I was met by a door-keeper once I had entered the building under my own steam.

[Image description: inside Opus One - not this bright; courtesy & © Radisson]

One enters the restaurant to be confounded by poorly lit gloom and the discreet, sub-optimal red-lighting of a brothel. There was no-one at the entrance nor at the bar to greet us, so we wound our circumspect way towards the day-light by the windows in the tea-room annexe. No salutation here either. We stood and waited to be seated at our pre-booked table. And we waited.

Not a good start but thankfully we had plenty to chat about. Once seated, we might have glanced at the menus, but there were none. A politely spoken waiter eventually decided to apprise us of the afternoon's offerings, a choice of two high teas. That was it. No offer of coffee if tea was not one's beverage.

We all selected the cold choice @ £18.95: finger sandwiches; scones with clotted cream and strawberry jam; three small cakes - a mini éclair, a mini walnut cake and a mini banoffee pie; and a jelly in a shot glass.

Some time later the waiter deposited our respective pots of tea, mixing up my Earl Grey and one of the breakfast teas, though I was brought my requested lemon. No hot water pot was brought over nor offered. We were given pot cups & saucers and not china.

Shortly afterwards the maître d' unceremoniously dumped on the table the tiered stands, which we had to swap over ourselves as he rushed away.

Sandwiches: there was a good choice of fillings - beef, egg, cheese, tuna, salmon, etc.; but some of the bread had already dried out and gone 'crusty' - not the most pleasant of mouth sensations.

[Image description: scone; courtesy Wikipedia]

Scones: these were light and to be sure the highlight of the repast; no butter was offered; no alternative to (overly sweet for my tastes) strawberry jam was offered; the clotted cream had a good firm texture but was not particularly flavoursome. One of my companions loved the spun-sugar decoration though, stating that it tasted of toffee-apples to her.

Cakes: The choux pastry on the éclair was tough and hard, the chocolate-coloured topping did not seem to have ever heard of cocoa let alone visited it; the walnut cake was just sugary sickliness; and I did not even attempt to sample the banoffee pie offering.

Jelly: there was so much gelatine in the jelly that it was almost set firm. There was not a hint of the alleged cider that was supposed to have flavoured it.

We ran out of tea rather quickly and before we had completed our meal. There were no staff on hand throughout most of our time at Opus One, so it took me some time to be able to order an Americano. It was served in the same style of ceramic as the tea and may have been instant as it was watery and flavourless brown water.

Attempting to settle the bill was also an ordeal. No staff anywhere. One of my other companions went to the bar only to find the barman pouring the remnants of one bottle of wine into another - which is just not done, ever.

There is plenty of choice for high tea in Manchester. Avoid Opus One and try one of the other venues! Nonetheless, I have eaten at other Radisson hotels across Europe. Manchester's Opus One on this occasion failed to live up to the chain's usually very high standards.

Thankfully, my companions were such jolly good company that the poor food and service were merely a minor irritant.

The Mangle (Wringer)

The sun is shining from a beautifully clear azure firmament this fine day. The air is mild and light zephyrs are rustling the desiccating leaves yet to fall from their boughs. It's a perfect autumnal day for getting outside in one's garden and doing some desperately needed tidying, pruning, lopping, etc. in between the more normal rains and blusteriness of this time of year.

[Image description: a dishevelled corner of the writer's garden]

Alas, today I am bed-bound. I cannot even descend the stairs to hobble out to just inspect my garden. All I can do is stare out of my window from my prone position in the bed and watch the occasional fluffy cotton-wool cloud float by and listen to the rustling trees whisper to one another.

Normally, this would be sufficient to lift my spirits; but for some unknown reason today I feel rather down.

Reflecting on why this may be so, I wonder whether it is related to my review and re-assessment last week by social services - my social worker is a lovely lady by the by.

At this time of year I am bed-bound approximately two in every three days. Most of the days I am not bed-bound I am house-bound. I have to turn more to the internet to do my shopping, as I increasingly find it difficult to go out and certainly do not do so on my own now, as my memory difficulties and dyscognition deteriorate. Over the year I average some fourteen-and-a-half hours of (unrefreshing) sleep per day; however at this time of year it can increase to almost twenty-four hours per day. Perhaps I am simply rueing the coming brumal months and my enforced hibernation.

Maybe, I am more upset that my social worker is keeping my assessment as unchanged. Apparently it is fine to only be able to: eat once per day; clean oneself every two to four days; change clothing every two to four days; etc. Thirty minutes Monday through Thursday to prepare a hot meal is considered to be sufficient for my needs. My bedding has not been changed in a month - social services do not cover that kind of thing believe it or not. Lord knows what level of service other folks receive.

I have worked for the State in two different capacities. I have paid tens of thousands in taxes. But now I am disabled and chronically ill, the State does not really want to know. At least that is how it feels…

Castigated, disparaged, ignored, resented - I feel like a burden. Personally, I blame the neo-liberal politicos and their cronies. Occasionally, I wish they would all be afflicted with temporary disability &/or chronic illness, long enough for them to be forced to claim State benefits and let them go through the DWP mangle. Perhaps then they might develop some sympathy, even empathy, for those of us who are less fortunate. Maybe then they would reform the DWP to work for we citizens and not agin us. Perhaps!



To press for changes to DWP, please sign WoWpetition.

Is DWP Harassing ESA Support Group Claimants?

I am not being starved by this contemptuous ConDem government's callous actions towards chronically sick &/or disabled folk due to being sanctioned. But I run the risk of being potentially sanctioned due to DWP incompetence, negligence or possibly harassment (if one believes the DWP are actually in control). The DWP appears to have a complete inability to deal with British citizens as individuals, but only as cases to be dealt with as quickly and as superficially as possible. The ConDems launched wide-ranging and extensive social security (they say 'welfare') reforms at the same time as cutting the number of workers able to deal with all the changes. The result unsurprisingly appears to be chaos. Folk are not waiting weeks for decisions and responses, but quite literally months. The DWP standard response is that they did not receive a letter - hence I send everything recorded, so know full well that they have received all my communications.

The latest instalment of my ongoing ESA50 saga follows. Today I finished drafting my response to a DWP letter which can be found below.

Dear Sir/Madam [I am unable to address this letter correctly as you failed to advise me as to by whom the letter was issued],

I was shocked, dismayed and then angry at receiving your letter dated 5th November on Friday 9th inst. in relation to a “Work-focused interview for Employment and Support Allowance claimants” as you caused me to have a full-blown panic-attack yet again and yet again I am presuming totally unnecsesarily.

My last communication from DWP in respect to ESA was ***’s letter of 4th April 2013, a copy of which is appended, in which he states, penultimate paragraph:

“You have been placed in the support group because your illness or disability restricts the possibility of working. This means you do not have to take part in any work-related activity…”

Nowhere in your current letter does it state, nor even imply, that this work-related interview is voluntary.

In the circumstances, I expect a full explanation as to why I am being harassed, given my health issues. Alternatively, if there has been a change of policy, please provide me with a copy of the relevant regulations as I have not seen nor heard anything about such a change. I can then take the matter up with Graham Brady MP.

I also append a copy of my letter of 10th - 27th April 2013 to *** Benefit Centre, which to date has remained unanswered. Perhaps you would be kind enough to provide me with the information I requested.

You should also be fully aware after all these years that I do NOT use the telephone due to disabilities. You failed to provide a reasonable alternative, i.e. an email address, and so are also in breach of disability legislation. You should review this matter urgently especially given that the Secretary of State desires that folk deal with benefit claims on-line.

Please ensure that your records are updated and confirm in writing that you have done so.

Given the number of failings by DWP and its agents in less than a year, I have to assume incompetency or negligence or deliberate harassment. If they continue I shall pursue all avenues open to me.

Yours faithfully,

Here are the scans of the DWP's letter:

If you would like to lend your support to those disabled &/or chronically sick folk, their carers and supporters who are fighting for a review of the way DWP treats individuals, please sign WoWpetition via wowpetition.com or via the official government epetition website. If you are a young carer or a child with a disability, you also can sign as long as you have your own email address and are a UK citizen.

Brunch: Potted Crab on Sourdough Rye

Regular readers will by now have realised (see my various reviews if not!) that I am a bit of a foodie - not quite a gourmand as my palate is not sufficiently refined. I have previously blogged about eateries I have - on the whole - enjoyed. However I have never actually posted on specific food products. I am about to do so. In so doing, I must point out that I have not and do not anticipate any kind of reward or remuneration for any positive comments.

The reason I have been inspired to write is due to having just enjoyed the best brunch since last Christmas Day.

One may be wondering why I am consuming brunch mid-afternoon (14.30 - 15.00). Well, it is down to my various health conditions and medications. I rarely have physical hunger pangs. Hunger for me is solely a mental & emotional experience. Additionally, I have to be able to descend the stairs, which on many days is not at all, so must await my carer coming in the evening to prepare me a meal.

Back to the brunch: as far as I am concerned the following is a perfect pairing. I brunched on two slices of "Light Sourdough Rye Bread", baked by the Gloucestershire Authentic Bread Company, liberally spread with Seafood & Eat It's "Cornish Potted Crab". Whilst full rye bread is perfect with smoked salmon (already on order for Christmas!), this lightly rye'd sourdough's more delicate flavour allowed the full piquancy of the spiced but nevertheless creamy-textured crabmeat to tantalise my taste-buds. The packaging for the crab recommends toast; however, the soft but firm bread meant one could indulge a satisfying tug before enjoying a good mastication.

[Image description: loaf & crab product; © Able & Cole and Seafood & Eat It respectively]

I accompanied my savour sensation with half-a-dozen heirloom tomatoes, two each of three varieties. Every last one was completely flavourless, barring a very slight acidic bitterness. The nomenclature heirloom does rather imply old-fashioned, the tommies of yore, full of sunny relish. Sadly, in this instance not so. Nonetheless they were, every last one, firm, juicy and attractive to the eye.

[Image description: assorted heirloom tomatoes; © Abel & Cole]

All three products were delivered this morning along with the rest of my weekly groceries by Able & Cole. For the past few months they have proved reliable and for the most part have delivered quality produce, with one or two minor exceptions. Even from a supermarket, one buys the odd dud product. So fair enough. I would heartily recommend giving them a go if they deliver to your place of residence.