🍆 Double Penis Syndrome

👶🏻 Baby born with 3 penises and no anus. Rare medical case.

Case report

When you think things can’t get any stranger.

Earlier this year in April 2023, a baby boy was born in Pakistan with two functional penises and no anus, as published in International Journal of Surgery Case Reports.

Immediately after his birth, the boy’s parents took him to the Children’s Hospital at the Pakistan Institute of Medical Sciences. Upon examination by doctors, they reported he had two “normal-shaped” phalluses, one of which was 1 cm larger than the other. Diagnostic imaging scans revealed the child had a single bladder attached to two urethras - allowing him to pass urine from both penises.

They also noticed that the boy had no anal opening, which is an immediate medical emergency since it is required to pass stool. Doctors decided to divert one end of the child's colon through an opening in the lower left side of his abdomen, allowing the child to defecate, using a procedure called a colonoscopy. No surgical intervention was performed to remove the extra penis.

The child was discharged home after two days.

What is Diphallia?

Diphallia is a rare genetic condition that occurs when an infant is born with a duplication of the penis. There are various types of diphallia, ranging from complete to partial penile duplication. Having two completely developed penises, or true diphallia, is very rare. There is often size discrepancy, and orientation is most commonly side by side.

Various representations and positioning of diphallia.

Source: ROCHE Magazine

The etiology is largely unknown but suggests to be due to a failure of mesodermal banding. Some researchers suggest that exposure to drugs, infections, or other damage between the 23rd and 25th day of gestation could lead to diphallia, as this is a crucial stage of fetal development. (Kundal et al, 2013)

The condition is classified under two types of diphallia: true diphallia and bifid phallus. These two groups are further subdivided into complete or partial duplication. True complete diphallia refers to complete penile duplication, each penis having two corpora cavernosa and a corpus spongiosum. If only one corpus is present in each penis, the term bifid phallus applies. When the degree of separation is complete up to the base of the shaft, it is called complete bifid phallus

Pompeian Lupanar showing Priapus with a double phallus.

Prevalence

Diphallia is estimated to occur in 1 out of 5–6 million births, with approximately 100 patients being reported within reported literature. The oldest reported case of diphallia was in 1609 by Johannes Jacob Wecker; ‘in Bologna during public dissections the cadaver of a man who had a double penis’, however the earliest pictorial record of diphallia dates back to 1862 in the Lupanar (Latin for brothel) in Pompeii, in which a painting on the wall depicted a man with complete diphallia. (Galassi, Henneberg &Habicht, 2016)

Signs and symptoms

When a baby boy is born with diphallia, on examination doctors may notice abnormalities in his penis, scrotum, or testicles.

Two of the most common ways that diphallia manifests, according to The Human Phenotype Oncology:

Between 80 - 99% of people with diphallia exhibit one or both of the following:

• Penile duplication- penis divided into two parts

• Cleft scrotum- scrotum divided into two parts

In addition, diphallia also manifests in various other, less common ways. Approximately 30 - 79% of people with diphallia may display any of the following associated conditions:

• anal atresia (incomplete or absence of anal opening)

• distal urethral duplication

• ectopic scrotum (abnormal scrotum positioning)

Some of the less common associated conditions of diphallia account for only 5–29% of boys:

• abnormal sperm production

• abnormal position of the kidneys

• abnormality of the pubic bone

• atrial septal defect (hole between the heart chambers)

• bladder exstrophy (bladder growth outside the body)

• cryptorchidism (undescended testicle)

• epispadias (abnormal opening of penis)

• Inguinal hernia

(Source: healthline.com)

Diagram representation of cryptorchidism (undescended testicle). Source: Invitra.com

Treatment

Treatment of diphallia is typically approached on an individual basis, as no two patients are the same. The associated anomalies are a major cause of mortality in diphallia patients, and treatment is typically done in a stepwise manor, with corrections aimed at the anomalies. Surgery typically involves cutting off the extra phallus and its urethra. Doctors attempt to proceed with the least obtrusive route possible when managing patients, so surgery may not always be required as in the case mentioned above.

As was the case previously in a case report involving a 54 year old married man and father of four children who consulted the physician for an inguinal hernia, discovering penile duplication during the examination. This individual opted out of treatment and lived a normal life. Published in the Medical and Surgical Urology Journal (Kouka et al, 2016)

Prognosis

Prognosis largely depends on whether it is a case of penile duplication with various associated anomalies or one of isolated penile duplication. The duplication of the phallus may be orthotopic or ectopic, symmetric or asymmetric in shape and size. Infants born with diphallia can grow up to live a normal life span and enjoy fulfilling lives. Diphallia is not a terminal illness as it is almost always noticed at birth and intervention is planned immediately.

For educational purposes only - not to be taken for medical advice.

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