Independent (UK)  [Printer-friendly version]
September 12, 2006

CAN CHEMICALS IN OUR HOMES CAUSE DEFORMITIES?

[Rachel's introduction: Growing numbers of boys are being born with
malformed genitals. Are chemicals in our homes to blame?]

By Hannah Duguid

At 16 weeks pregnant, Isobel Lockwood had an ultrasound and was told
she was carrying a baby girl. Soon afterwards, DNA taken from the
foetus during an amniocentesis showed it was a boy. The doctor, who'd
never made such a mistake before, was astonished but thought nothing
further of it.

When Isobel eventually gave birth, the reason for the mix-up became
clear. Her son's penis was tiny and split down the middle.

The immediate diagnosis was hypospadias -- a birth abnormality where
the hole in the penis lies underneath the shaft, or in more severe
cases, at the base of the penis or underneath the scrotum. In some
cases the penis is very bent and will grow back on itself, in the
shape of a doughnut. In severe cases, it is difficult to identify a
penis at all.

At best the problem is largely cosmetic and can be rectified in a
single operation. At worst (and with modern surgery these cases are
rare), boys are left infertile and unable to have sex.

Of every 150 to 200 boys born in this country, one will have
hypospadias -- and doctors believe that cases have doubled over the
past 25 years. It happens during the first three or four months of
pregnancy and is a result of incomplete masculinisation.

Basically, we all begin life in the womb as female, but with
hypospadias something disrupts the hormonal changes a foetus goes
through to become male. What that "something" might be turns out to be
fairly chilling.

Research in Denmark points to a group of chemicals -- phthalates -
found in objects and everyday products all around us. They are in
plastic, carpets, fabric, make-up, food packaging, perfume, cosmetics,
milk, vegetables, pesticides and sun cream. Known as endocrine
disrupters, it is believed they upset the delicate balance of hormones
during the early stages of pregnancy.

Related to this is the general crisis in male fertility in the West.
One in six boys born today will have a low sperm-count. Hypospadias
sufferers are part of a much wider problem which has seen male
fertility drastically decline over the past 50 years.

Professor Richard Sharpe of the Medical Research Council's Human
Reproductive Sciences Unit suggests that there's a link between
incidents of hypospadias, undescended testes, low sperm-count and
testicular cancers. "We don't yet know the exact cause of these
problems, but they are all inter-related. It seems that the increase
in these abnormalities is to do with environmental and lifestyle
factors. It is something that has only happened recently," Sharpe
says.

Aivar Bracka, a consultant genito-urethral plastic surgeon at Russells
Hall Hospital in Dudley, operates on hundreds of cases of hypospadias
every year. "I would be surprised if there wasn't an environmental
cause for it. It is difficult to explain any other way. In particular,
it explains cases of identical twins where one is born with
hypospadias and the other isn't. This means that genetics doesn't
account for everything."

Hereditary factors do, however, play a part in some cases. It is not
unusual for more than one male in a family to have hypospadias. If the
father and grandfather has it, there is a one in three chance that the
next male in line will have it.

But mostly, it happens out of the blue. "I had no idea what
hypospadias was," says Sue Phipps, mother of identical twins Henry and
Charlie, 11, both born with the condition. "I didn't notice
immediately as I had not had boys before. The nurse pointed it out.
Both of them had their hole half-way down the underneath of their
penis, and both had a hooded foreskin. They had to sit on the toilet
to pee, or it went everywhere.

"We were told they would need one operation, but after a series of
operations their penises were a mess. The pain was so severe they were
on morphine. Going to the loo was dreadful for them; Henry urinated
from three holes and Charlie from five."

A traumatic two years culminated in Sue Phipps threatening to sue the
surgeon. One of the problems when local plastic surgeons operate on
hypospadias patients is that they are not sufficiently experienced in
the delicate technique required and end up making the problem worse -
one-third of cases operated on by Bracka are repair jobs.

Once referred to Russells Hall Hospital, the boys needed just one
"salvage" operation to give them a penis that looked normal and
worked. Both were able to get erections.

But Phipps does not yet know whether her boys will be fertile. There
is a small but significant chance that they won't be. Studies have
shown that boys with hypospadias tend to have a slightly lower sperm-
count. The twins' testicles are normal, though. One in 10 boys with
hypospadias is also born with undescended testicles. If one testicle
descends there is, again, a small but significant increase of
infertility. If both fail to descend, that likelihood shoots up to 80
per cent.

The other reason hypospadias sufferers may struggle to have children
is if their abnormality makes it difficult to have sex. A penis with a
270-degree bend can be surgically corrected, but if it is not
penetration is almost impossible -- as is normal ejaculation if the
hole is at the base of the penis. Ham-fisted surgery leaves the
urethra "baggy", causing weak ejaculation where sperm dribbles rather
than shoots out.

A penis that doesn't look or behave like everybody else's is upsetting
for a boy, too. Their penises tends to be smaller than usual and,
apart from embarrassment with potential sexual encounters, there is
"locker room syndrome", when boys face the rough judgements of their
peers.

Peter Cuckow, consultant paediatric urologist at Great Ormond Street
Hospital and the Institute of Urology, says: "People are much more
critical of their anatomy now, which means operations take place that
wouldn't have years ago. I have known families where all the men had
hypospadias but the older generations had not had operations because
all that was wrong was that their penis looked strange. It still
worked, so it wasn't a problem."

Isobel Lockwood says: "I am most worried about how to talk to my son
about his penis. I don't want there to be any shame about it, but
there's no point pretending nothing's wrong. You want them to be the
same. But I do worry about what will happen when he reaches puberty."

Sometimes it is fathers who find it difficult to cope. "I suppose it's
because they see it as their manhood," says Dionne Smith, 38. "When my
boys went into hospital to have their operation, my ex-partner told
his friends that the boys were on holiday. I didn't like that. I told
him it wasn't a disease -- or anything to be afraid of."

What is important is that for most boys born with hypospadias, one or
two operations when they're very young will correct the condition. It
is also true that surgeons expect to see more cases in the future -
and unless something changes there is nothing we can really do about
it.

Support group: www.hypospadias.co.uk Some names have been changed

Phthalates: what you need to know

What are phthalates?

Phthalates (pronounced "thal-ates") are a group of chemical liquids
used as "plasticisers" -- substances that modify the physical
properties of materials. Resembling vegetable oil, odourless, they
belong to a family of workhorse chemicals that have been in use for 50
years. They are created by the simple reaction of alcohols with
phthalic anhydride and the elimination of water.

How do they work?

They are most commonly used to soften polyvinyl chloride (PVC), thus
creating a soft and flexible texture.

What are they used for?

Items such as footwear, electrical cables and stationery, as well as
medical devices such as tubing and blood bags. The larger-molecule
variety is what gives flexibility to some vinyl flooring and
children's toys. The smaller-molecule type serves as a fixative for
perfumes to slow evaporation and help the scent to linger. Nail
varnishes, adhesives and safety glass gain more supple textures thanks
to phthalates.

The European Parliament will be finalising legislation this autumn on
the use of toxic chemicals in household products. Greenpeace, which is
locking horns with the chemical industry lobby over this issue, is
working to ensure that the legislation is strong enough to make a
difference.

The environmental campaign group wants to see the use of phthalates, a
group of chemicals that may be responsible for disrupting hormones
during pregnancy, restricted and safer ones used. It also wants the
chemical content of products to be clearly stated on labels so that
consumers know what to avoid.

Sarah Shoaka of Greenpeace says: "These chemicals are so widespread.
We're using ourselves as an experiment and by the time we know the
results, it will be too late."

Whether Greenpeace can succeed against the might of the chemicals
industry remains to be seen -- and no one knows for certain that, even
if they do, the rise in conditions such as hypospadias can be
reversed. But it does seem clear that some lifestyle and environmental
factors must be addressed.

For a list of products to avoid, see
www.greenpeace.org.uk/products/toxics

At 16 weeks pregnant, Isobel Lockwood had an ultrasound and was told
she was carrying a baby girl. Soon afterwards, DNA taken from the
foetus during an amniocentesis showed it was a boy. The doctor, who'd
never made such a mistake before, was astonished but thought nothing
further of it.

When Isobel eventually gave birth, the reason for the mix-up became
clear. Her son's penis was tiny and split down the middle.

The immediate diagnosis was hypospadias -- a birth abnormality where
the hole in the penis lies underneath the shaft, or in more severe
cases, at the base of the penis or underneath the scrotum. In some
cases the penis is very bent and will grow back on itself, in the
shape of a doughnut. In severe cases, it is difficult to identify a
penis at all.

At best the problem is largely cosmetic and can be rectified in a
single operation. At worst (and with modern surgery these cases are
rare), boys are left infertile and unable to have sex.

Of every 150 to 200 boys born in this country, one will have
hypospadias -- and doctors believe that cases have doubled over the
past 25 years. It happens during the first three or four months of
pregnancy and is a result of incomplete masculinisation.

Basically, we all begin life in the womb as female, but with
hypospadias something disrupts the hormonal changes a foetus goes
through to become male. What that "something" might be turns out to be
fairly chilling.

Research in Denmark points to a group of chemicals -- phthalates -
found in objects and everyday products all around us. They are in
plastic, carpets, fabric, make-up, food packaging, perfume, cosmetics,
milk, vegetables, pesticides and sun cream. Known as endocrine
disrupters, it is believed they upset the delicate balance of hormones
during the early stages of pregnancy.

Related to this is the general crisis in male fertility in the West.
One in six boys born today will have a low sperm-count. Hypospadias
sufferers are part of a much wider problem which has seen male
fertility drastically decline over the past 50 years.

Professor Richard Sharpe of the Medical Research Council's Human
Reproductive Sciences Unit suggests that there's a link between
incidents of hypospadias, undescended testes, low sperm-count and
testicular cancers. "We don't yet know the exact cause of these
problems, but they are all inter-related. It seems that the increase
in these abnormalities is to do with environmental and lifestyle
factors. It is something that has only happened recently," Sharpe
says.

Aivar Bracka, a consultant genito-urethral plastic surgeon at Russells
Hall Hospital in Dudley, operates on hundreds of cases of hypospadias
every year. "I would be surprised if there wasn't an environmental
cause for it. It is difficult to explain any other way. In particular,
it explains cases of identical twins where one is born with
hypospadias and the other isn't. This means that genetics doesn't
account for everything."

Hereditary factors do, however, play a part in some cases. It is not
unusual for more than one male in a family to have hypospadias. If the
father and grandfather has it, there is a one in three chance that the
next male in line will have it.

But mostly, it happens out of the blue. "I had no idea what
hypospadias was," says Sue Phipps, mother of identical twins Henry and
Charlie, 11, both born with the condition. "I didn't notice
immediately as I had not had boys before. The nurse pointed it out.
Both of them had their hole half-way down the underneath of their
penis, and both had a hooded foreskin. They had to sit on the toilet
to pee, or it went everywhere.

"We were told they would need one operation, but after a series of
operations their penises were a mess. The pain was so severe they were
on morphine. Going to the loo was dreadful for them; Henry urinated
from three holes and Charlie from five."

A traumatic two years culminated in Sue Phipps threatening to sue the
surgeon. One of the problems when local plastic surgeons operate on
hypospadias patients is that they are not sufficiently experienced in
the delicate technique required and end up making the problem worse -
one-third of cases operated on by Bracka are repair jobs.

Once referred to Russells Hall Hospital, the boys needed just one
"salvage" operation to give them a penis that looked normal and
worked. Both were able to get erections.

But Phipps does not yet know whether her boys will be fertile. There
is a small but significant chance that they won't be. Studies have
shown that boys with hypospadias tend to have a slightly lower sperm-
count. The twins' testicles are normal, though. One in 10 boys with
hypospadias is also born with undescended testicles. If one testicle
descends there is, again, a small but significant increase of
infertility. If both fail to descend, that likelihood shoots up to 80
per cent. The other reason hypospadias sufferers may struggle to have
children is if their abnormality makes it difficult to have sex. A
penis with a 270-degree bend can be surgically corrected, but if it is
not penetration is almost impossible -- as is normal ejaculation if
the hole is at the base of the penis. Ham-fisted surgery leaves the
urethra "baggy", causing weak ejaculation where sperm dribbles rather
than shoots out.

A penis that doesn't look or behave like everybody else's is upsetting
for a boy, too. Their penises tends to be smaller than usual and,
apart from embarrassment with potential sexual encounters, there is
"locker room syndrome", when boys face the rough judgements of their
peers.

Peter Cuckow, consultant paediatric urologist at Great Ormond Street
Hospital and the Institute of Urology, says: "People are much more
critical of their anatomy now, which means operations take place that
wouldn't have years ago. I have known families where all the men had
hypospadias but the older generations had not had operations because
all that was wrong was that their penis looked strange. It still
worked, so it wasn't a problem."

Isobel Lockwood says: "I am most worried about how to talk to my son
about his penis. I don't want there to be any shame about it, but
there's no point pretending nothing's wrong. You want them to be the
same. But I do worry about what will happen when he reaches puberty."

Sometimes it is fathers who find it difficult to cope. "I suppose it's
because they see it as their manhood," says Dionne Smith, 38. "When my
boys went into hospital to have their operation, my ex-partner told
his friends that the boys were on holiday. I didn't like that. I told
him it wasn't a disease -- or anything to be afraid of."

What is important is that for most boys born with hypospadias, one or
two operations when they're very young will correct the condition. It
is also true that surgeons expect to see more cases in the future -
and unless something changes there is nothing we can really do about
it.

Support group: www.hypospadias.co.uk Some names have been changed

Phthalates: what you need to know

What are phthalates?

Phthalates (pronounced "thal-ates") are a group of chemical liquids
used as "plasticisers" -- substances that modify the physical
properties of materials. Resembling vegetable oil, odourless, they
belong to a family of workhorse chemicals that have been in use for 50
years. They are created by the simple reaction of alcohols with
phthalic anhydride and the elimination of water.

How do they work?

They are most commonly used to soften polyvinyl chloride (PVC), thus
creating a soft and flexible texture.

What are they used for?

Items such as footwear, electrical cables and stationery, as well as
medical devices such as tubing and blood bags. The larger-molecule
variety is what gives flexibility to some vinyl flooring and
children's toys. The smaller-molecule type serves as a fixative for
perfumes to slow evaporation and help the scent to linger. Nail
varnishes, adhesives and safety glass gain more supple textures thanks
to phthalates.

The European Parliament will be finalising legislation this autumn on
the use of toxic chemicals in household products. Greenpeace, which is
locking horns with the chemical industry lobby over this issue, is
working to ensure that the legislation is strong enough to make a
difference.

The environmental campaign group wants to see the use of phthalates, a
group of chemicals that may be responsible for disrupting hormones
during pregnancy, restricted and safer ones used. It also wants the
chemical content of products to be clearly stated on labels so that
consumers know what to avoid.

Sarah Shoaka of Greenpeace says: "These chemicals are so widespread.
We're using ourselves as an experiment and by the time we know the
results, it will be too late."

Whether Greenpeace can succeed against the might of the chemicals
industry remains to be seen -- and no one knows for certain that, even
if they do, the rise in conditions such as hypospadias can be
reversed. But it does seem clear that some lifestyle and environmental
factors must be addressed.

For a list of products to avoid, see
www.greenpeace.org.uk/products/toxics

Copyright 2006 Independent News and Media Limited