Shaping parents, shaping penises: How medical teams frame parents’ decisions in response to hypospadias

Roen, Katrina and Hegarty, Peter (2018). Shaping parents, shaping penises: How medical teams frame parents’ decisions in response to hypospadias. British Journal of Health Psychology, 23(4) pp. 967–981.

DOI: https://doi.org/10.1111/bjhp.12333

URL: https://doi.org/10.1111/bjhp.12333

Abstract

Introduction

Psychological research provides insights into how parents approach medical decisions on behalf of children. The medical decision of concern here is the surgical alteration of a hypospadic penis, whose urethral opening does not appear at the tip. Hypospadias surgery is routinely carried out in infancy, despite criticism by international organizations concerned about children’s rights. The focus of this study is on the framing of hypospadias surgery.

Objectives

The objective is to examine how health professionals frame hypospadias and hypospadias surgery in medical and non-medical ways.

Design

This is a qualitative study designed to build on the experimental research of Streuli et al who investigated how medical versus non-medical information affects decision-making about non-essential childhood genital surgery.

Methods

Semi-structured interviews were undertaken with 32 health professionals. Theoretically informed thematic analysis was used to examine how health professionals talk about hypospadias surgery and about supporting parents to make treatment decisions.

Results

The analysis suggests that medical professionals’ engagement with parents underestimates the effect of framing in influencing parental decisions about hypospadias surgery. Some psychological specialists in this area are actively framing hypospadias in ways that enable some parents to choose a non-medical pathway. Psychologically informed ways of talking about a child’s genital difference focus on psychological qualities, including affect, well-being, and unconditional positive regard.

Conclusions

The best interests of children with hypospadias may well be served when psychological pathways are highlighted, providing opportunities to support the flourishing of children whose genital appearance raises the question of medical intervention.