Penectomy

Overview

Penectomy is a surgical procedure done as a primary treatment for penile cancer or as part of gender-affirming surgery. The procedure involves surgically removing the penis, either partially or completely.

A penectomy may be part of gender affirmation surgery for transgender women or nonbinary people who choose not to keep their penis. It is also a common treatment for penile cancer. In cases where a total penectomy is performed, the urethra is relocated to allow the individual to continue urinating.

Reasons for undergoing the procedure

A penectomy is typically performed for two reasons:

• Treating penile cancer: Risk factors for penile cancer include smoking, being uncircumcised, having HPV or AIDS, being over 50, undergoing UV light treatment for psoriasis, and having foreskin issues like phimosis or smegma buildup.
• Gender affirmation or gender nullification: Some individuals may choose to remove only the penis, while others may also remove the scrotum and testicles in a procedure known as gender nullification. Others may opt for additional procedures to feminize their genitals, such as creating a vulva or vagina. Gender affirmation surgery allows individuals to align their physical appearance with their gender identity, with the specific approach tailored to their personal goals.

Risk

Penectomy is a major surgical procedure that carry certain risks, such as:

• Infection
• Severe bleeding
• Lymphedema in the legs, which can cause fluid buildup in the scrotum, especially after cancer surgery
• Urinary tract infection

Before the procedure

The extent of a penectomy for penile cancer depends on the cancer’s progression, with less invasive cases requiring the removal of less tissue. It is crucial to choose a healthcare provider experienced in this procedure, who will discuss all available surgical options before proceeding.

During the procedure

The surgical procedure of penectomy depends on the underlying reason for undergoing the procedure.

Penectomy for cancer treatment

A penectomy is a surgical procedure that involves the removal of part or all of the penis, typically done for two main reasons: treating penile cancer or as part of gender affirmation surgery. Penile cancer is rare, but it tends to occur more often in individuals over the age of 50, especially those who smoke, are uncircumcised, or have conditions like HPV or AIDS. In cases of cancer, a partial penectomy may be performed to remove the tumor while preserving as much tissue as possible, whereas a total penectomy involves the complete removal of the penis when the cancer is more advanced.

For individuals seeking gender affirmation surgery, a penectomy may be part of their transition process. This surgery can be a standalone procedure to remove the penis or can be combined with the removal of other external genitalia as part of gender nullification. For those who want to feminize their genitals, the procedure might also involve preserving tissue to create a vulva or vagina. The decision and approach to surgery are highly individualized and may vary depending on personal goals and needs.

Before the procedure, patients meet with a specialized surgeon to discuss the details and options available. During surgery, in cases of cancer, the extent of the removal depends on how invasive the tumor is. If the entire penis is removed, the urethra may be rerouted to the perineum, requiring the patient to sit when urinating. In some cases, reconstructive surgery, such as a phalloplasty, may be considered later.

Penectomy for gender affirmation or gender nullification: Gender nullification surgery involves the removal of the penis as part of bottom surgery, often chosen as the final step for individuals seeking this procedure. Unlike gender-affirming surgery, where individuals have additional options for how they want their genitals to look and function, gender nullification focuses on creating a smooth and level genital area. This approach aligns more closely with the self-perception of some gender non-conforming individuals who prefer a neutral or non-binary presentation.

For those seeking a more feminizing procedure, options like vulvoplasty and vaginoplasty are available. A vulvoplasty creates external parts of the vulva, including the mons, clitoris, and labia, using tissue from male anatomy at birth, such as the glans to form the clitoris. A vaginoplasty, on the other hand, creates a vaginal canal between the bladder and rectum, with penis inversion vaginoplasty being the most common and highly regarded method. Both surgeries offer individuals the opportunity to have their bodies more closely align with their gender identity.

After the procedure

After a penectomy, one can generally eat and drink as desired, but some swelling is expected, which may take time to heal. During recovery, a urinary catheter will be used for up to 14 days, and there may be a tube to drain blood from the wound. One will have to stay at the hospital for two to three days.

Outcome

Recovery period after a penectomy vary for each individual, so it is important to consult with a healthcare provider about expectations.

Typically, one will need to take a month off work, and be restricted to heavy lifting for 4-6 weeks. Compression stockings, medication, or a combination of both may be recommended to prevent blood clots, and swelling should gradually decrease over several weeks.

Following vulvoplasty or vaginoplasty, patients may need to use a conformer to maintain vaginal shape and a dilator during recovery to keep the vagina open.

Regular follow-up checkups are essential to monitor recovery. It is also important to be on look out for possible complications. Seek medical attention if any of the following is experienced:

• Pain that is not improved by taking medication
• Heavy bleeding
• High temperature
• Symptoms intensify, or new ones occur

The advantages of a penectomy are significant. For those undergoing the procedure as part of gender affirmation surgery, it aligns the physical body with their gender identity. For those with penile cancer, a penectomy offers the best chance for survival.