Let’s talk about SEX: Sexuality and fertility in people with a medical history in pediatric urology

In this article we describe fertility and the sexual aspects of several (pediatric) urological conditions: hypospadias, spina bifida and bladder exstrophy-epispadias. Hypospadias is a very common condition. Especially males with a more severe, proximal hypospadias can develop problems with sexual wellbeing. Approximately 10% experience difficulties with erections and ejaculation. The overall sexual wellbeing seems to be comparable to that of men without hypospadias. Spina bifida patients are sexually active and have just as much sexual desire as the general population. Fertility in general is reduced and female patients need adjusted doses of folic acid preconception. Urine- and fecal incontinence are important negative factors for sexual wellbeing. Bladder exstrophy-epispadias is very rare, but the complexity of this condition requires transition of care and long-term follow-up. Extensive reconstructions may be associated with problems in various phases of life. The cosmetic appearance of the penis is often a point of concern due to a short and wide aspect despite reconstruction. Urological involvement during pregnancy is preferable in mothers with exstrophy. In general, patients with these conditions are in need of good education and guidance. Preferably pro-active, thus initiated by the doctor, and with easy access to a psychologist and/sexologist.