[Pharmwaste] Article from the UK: Genital abnormalities blamed on "gender-bending" chemicals

Wed Oct 18 10:48:12 EDT 2006

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in
_article_id=409521&in_page_id=1774
09/10/06 - Health section 

Could chemicals have destroyed my sons' chances of becoming fathers?

By ANGELA EPSTEIN, Daily Mail 

Each year more than 1,200 boys in the UK are born with a genital
abnormality. Experts say the number has doubled over the past 25 years,
and that "gender-bending" chemicals are to blame. 
Correcting such abnormalities can be a traumatic experience for both
child and parent. Here a mother whose sons were affected describes their
experience. 

Sue Phipps gave birth to twin boys after a six-hour labour and she was
thrilled when the two dark-haired bundles were placed in her arms. But
euphoria quickly turned to confusion when she was told that both boys
had been born with malformed penises. 

"I just couldn't understand it. I'd had a straightforward pregnancy and
nothing had ever shown up on any of my scans to suggest there was a
problem," says Sue, 43. 

Yet what the scans were not able to show was that her sons had
hypospadias. This is a condition where the opening of the urethra (the
tube that carries urine and semen out of the body) is on the underside
of the penis instead of at the end. 

In some cases the penis curves downwards, with the foreskin covering
only the front. In severe forms of hypospadias the urethral opening is
so far back it is almost in the scrotum. 

"As I held my newborn children I could see that the hole through which
the boys would pass urine was not at the tip of the penis but halfway
down, further underneath," says Sue. 

"I realised it didn't look right, but I was so glad that my babies had
been born without any life-threatening complications that my main
feeling was relief. It was my husband who was really shocked by the
boys' condition. As a father, he couldn't believe this vital part of
their manhood was somehow malformed." 

Mr and Mrs Phipps were told that while the immediate physical problem
could be corrected with surgery, the condition was also linked to low
sperm count and a higher risk of developing testicular cancer. 

Hypospadias can be triggered by a random genetic fault - and initially
the doctors suggested this as the cause of their sons' problem. However
the Phipps have no family history of the condition, and they and their
specialist are convinced environmental factors are to blame. 

There is increasing evidence to show that male reproductive
abnor-malities such as this are linked to exposure to "gender-bending"
chemicals found in everyday products such as shampoo and carpets. 
These chemicals are known as hormone disruptors or EDCs - endocrine
disrupting chemicals. They include phthalates, a group of chemical
liquids which are used to give many ordinary products a flexible
texture. 
Phthalates are found in plastic, carpets, fabric, make-up, perfume,
cosmetics, milk, vegetables and pesticides. 

In a two-year experiment by the Medical Research Council's Human and
Reproductive Sciences Unit in Edinburgh, rats exposed to high levels of
phthalates had double the rate of genital defects and low sperm counts. 
More crucially, in the first human study, researchers from the
University of Rochester in New York have now linked exposure to
phthalates to a higher risk of genital abnormalities in baby boys. 

The researchers, who examined 134 boys, found women with higher levels
of phthalate-related chemicals in their blood were more likely to give
birth to babies with undescended, or small testicles and small penises. 
Professor Richard Sharpe of the MRC?s Human Reproductive Sciences Unit
believes that all these male reproductive abnormalities are
inter-related and that the increase is linked to environmental and
lifestyle factors. 

"The problem is that we don't know the exact cause. But the fact is that
phthalates are the most ubiquitous of environmental chemicals. They
contaminate house dust, even rain water. There is no definitive proof
yet that they are linked to male birth abnormalities. But they are a
strong candidate."

Aivar Bracka, a consultant genito-urethral surgeon who specialises in
hypospadias, is convinced that environmental factors are to blame.

'All the solid evidence points to a strong link between the rise of male
reproductive abnormalities and something in our environment.' 

"Hereditary factors can only partly explain hypospadias", he says. "For
example I have seen twins where one has the condition and one hasn't
even though the children are genetically identical. That situation can
only arise from an external factor affecting fetal development.
Otherwise both twins would be affected." 

The theory is that phthalates interfere with the manufacture of the male
sex hormone, testosterone at a critical stage in fetal development - the
first three or four months of pregnancy. It is testosterone which gives
a fetus its male characteristics. 

There is no doubt that women in particular are vulnerable to chemical
exposure. According to Julia Mitchell, spokeswoman for environmental
website www.chemicalsafeskincare.co.uk, the average woman will use 12
different cosmetic products a day - unwittingly applying 175 different
chemicals to her body. 

And in recent tests carried out by WWF, formerly the World Wide Fund for
Nature, man-made pollutants and chemicals were found in every one of 27
food products tested, including bread and eggs. 
The amount of contaminants was well within legal limits, but the worry
is that the chemicals may represent a serious risk when they mix
together in the body. 

At the moment it seems that only baby boys are at risk of reproductive
abnormalities. (Indeed Sue Phipps and her husband Peter, 52, a retired
businessman, have a 14-year-old daughter, Harriet, who has not suffered
any problems.)

However, as Professor Sharpe explains, "just because the studies have
not yet been carried out doesn't mean that females are not also
vulnerable".

Changes in women would be more subtle, and not visible. However there is
potential for any organ of the body to be affected by exposure to
chemicals. 

Sue, who gave birth to the twins at Warwick Hospital in April 1995, was
told that her sons' condition was 'mild to moderate'. 

And while there was no rush for surgery, it was clear the condition
could not be left untreated: the children would have been unable to pass
water standing up, since the urine would have been impossible to direct.

We also knew they could face psychological problems of having a penis
that looked different. And, though it seemed ridiculous to think of it
when they were so young, hypospadias could also compromise their ability
to have intercourse. 

'It seemed right to correct the problem while none of these things were
an issue.' 

In every other way the children were normal healthy boys. They were
referred to a consultant plastic surgeon at their local hospital who
assessed the boys every year until they were four. 

The operation was finally scheduled for July 2000 - by then they were
considered old enough to cope with surgery and the timing meant they
could start school in September without appearing 'different'. 
The surgery involved extending the existing urethra. This was done by
creating an artificial urethra using a tube of skin taken from the
foreskin and then stitching it to the end of the existing urethra. 
Grafting on this new piece of urethra would close the existing hole and
the plastic surgeon then guided the artificial urethra to the end of the
penis.

"It's awful watching not one, but two, of your children going down to
surgery," says Sue. 
"Henry went first for the 90-minute operation. And as he came back from
theatre, Charlie, who was already sedated, was wheeled down." 

In order to allow the stitches to heal, urine was not initially allowed
to pass down the new urethra. Instead the boys were fitted with a stent
which diverted urine from the bladder into a catheter bag. 
However shortly after the boys were brought back from theatre it was
clear something was wrong. Within 20 minutes they were both writhing in
agony. 

"It was terrifying to watch," says Sue. The problems seemed to be caused
by a blockage in the stent. During the children's week-long stay in
hospital, doctors had to reposition the catheter four times as on each
occasion their pain only intensified. 

The boys were not allowed to leave hospital until they could pass water
without the catheter. But when they tried urinating naturally their
parents were shocked by what she saw. 

"When Charlie tried, the urine came out of five tiny holes near the end
of his penis. When Henry did the same it came out of three holes. It
sounds crude but it was like looking at a hosepipe with tiny puncture
marks in it. Though we were assured these would heal naturally we were
horrified. Their penises looked grotesque too. From thinking that this
was just a routine operation I wondered if they would ever function
normally."

Hypospadias is technically difficult to correct and the Phipps sought a
second opinion. They consulted Aivar Bracka, a consultant
genito-urethral surgeon who specialises in hypospadias, at Wordsley
Hospital in Stowbridge. 

He suggested a six-week wait to allow the children to recover from their
trauma before carrying out corrective surgery - one-third of his
caseload comprises similar repair work. 

The "salvage" operation took an hour. "This time, thankfully, there were
no tears or pain," says Sue. "Within a week their catheters were taken
out and the boys healed quickly and were back at school within three
weeks. 
The boys now have a check-up every two years and will do so until the
age of 18." 

Although the boys have put the surgery behind them, Sue cannot but be
concerned about what might lie ahead. Studies have shown that boys with
the condition tend to have a slightly lower sperm count which could lead
to problems conceiving. There is also an increased risk of testicular
cancer.

"They haven't been offered any fertility tests and to be honest don?t
intend to pursue this unless it becomes an issue," says Sue. "Of course
it is at the back of my mind, but I don't dwell on it." 

So what can be done to protect future children from such abnormalities.
Later this month the EU parliament will vote on replacing hazardous
chemicals in everyday products with safer alternatives. 

In the meantime, Prof Sharpe suggests that pregnant women try to
minimise chemical exposure where they can. "One new study has shown how
rapidly the skin absorbs phthalates because it has such a large surface
area. So it is best for pregnant women to try to avoid applying body
creams and cosmetics." 

For Sue the message is clear. "I would urge all women who are thinking
of having babies to be aware of the chemicals in everyday life. We need
to raise awareness about the potential dangers." 

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in
_article_id=409521&in_page_id=1774
(c)2006 Associated New Media

Deborah L. DeBiasi
Email:   dldebiasi at deq.virginia.gov
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Virginia Department of Environmental Quality
Office of Water Permit Programs
Industrial Pretreatment/Toxics Management Program
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