Penectomy: Indications, Procedure & Common Questions

Penectomy is the partial or complete removal of the penis. It is mainly performed to treat penile cancer. It may also be needed after accidents, trauma, or severe injuries involving the penis.

This surgery is also medically known as penectomy or phallectomy. It is performed by a urologic surgeon using general anesthesia or epidural anesthesia with sedation.

After a penectomy, a hospital stay of a few days is usually needed. Recovery depends on the type of surgery performed, and usually involves avoiding strenuous activity for at least six weeks, keeping the incision clean and dry, and taking medications as prescribed.

Main indications

Penectomy may be recommended for:

• Penile cancer

• Accidents or trauma involving the penis

• Severe penile injuries

• Severe penile fracture

• Self-mutilation or genital mutilation

For people undergoing gender-affirming surgery, removal of the penis is not considered an amputation because the procedure involves reconstructive surgery to create female genital anatomy.

Penectomy is performed by a urologic surgeon in a hospital. In some cases, it may be done as emergency surgery.

Preparing for surgery

To prepare for penectomy, you should ask the surgeon any questions you have about the surgery, the technique that will be used, how much of the penis will be removed, recovery, and possible complications.

You should also tell the surgeon about all medications, vitamins, or herbal supplements you take regularly.

It is also important to let the medical team know if you have any allergies to anesthesia or other medications.

How it's done

Penectomy is performed by a urologic surgeon in a hospital using general anesthesia or epidural anesthesia with sedation.

During a penectomy, the doctor may use different techniques to remove part or all of the penis.

In a total penectomy, the entire penis is removed, and the surgeon creates a new urinary opening in the perineum, called a perineal urethrostomy.

In a partial penectomy, the glans, or head of the penis, is removed while part of the shaft is preserved. According to the American Cancer Society, surgeons try to preserve as much of the shaft as possible when performing this procedure. In cases of penile cancer, the testicles may also need to be removed.

Recovery time

Initial recovery from penectomy usually takes place in the hospital for 1 to 2 days. A urinary catheter is usually placed to drain urine and may stay in place for up to 14 days.

A surgical drain may also be used to drain blood or fluid from the surgical wound.

During the hospital stay, the doctor may prescribe pain relievers, anticoagulants, and antibiotics to help prevent infection.

Home care

After leaving the hospital, it is important to avoid intense physical activity or heavy lifting for at least six weeks, or as directed by your doctor.

You should also take all medications as prescribed and keep the surgical incision clean and dry.

When to see a doctor

Seek medical care right away if you develop:

• Fever

• Pain that does not improve with medication

• Heavy bleeding

• Redness or swelling around the incision

• Pus or fluid draining from the incision

A doctor should examine the incision and recommend the most appropriate treatment.

Frequently asked questions

Some common questions after a penectomy include:

1. Is it possible to have sex?

How penectomy affects sexual activity depends on how much of the penis was removed.

People who have a total penectomy may not have enough remaining tissue for penetrative sex. However, different sex toys or devices may be used as alternatives.

After a partial penectomy, it may be possible to have sex again after about 2 months, once the area has healed well and the doctor says it is safe.

In many cases, the man may have a prosthesis placed in the penis during surgery, or the remaining part of the penis may still be enough to maintain pleasure and sexual satisfaction for both partners.

2. Is it possible to reconstruct the penis?

In cases of cancer, the urologist usually tries to preserve as much of the penis as possible during surgery. This may allow the remaining tissue to be reconstructed later through neophalloplasty, using skin from the arm or thigh and prosthetic devices, for example.

In cases of traumatic amputation, the penis can often be reattached to the body if surgery is performed as soon as possible, ideally within a few hours. This helps prevent death of the penile tissue and improves the chances of success.

The final appearance and success of the surgery can also depend on the type of cut. Outcomes are generally better when the cut is smooth and clean.

3. Does amputation cause a lot of pain?

Severe pain can occur when amputation happens without anesthesia, such as in cases of mutilation, and may even cause fainting. After recovery, many men may also feel phantom pain in the area where the penis used to be.

This type of pain is common in people who have had an amputation. The brain may take a long time to adapt to the loss of a body part, which can lead to sensations such as tingling or pain in the amputated area during daily life.

4. Does libido stay the same?

Sex drive in males is regulated by testosterone, which is produced mainly in the testicles. Men who have a penectomy without removal of the testicles may continue to have the same libido as before.

Although this may seem positive, it can cause significant frustration in people who have had a total penectomy and cannot have penile reconstruction, as it may be harder for them to respond to their sexual desire.

5. Is it possible to have an orgasm?

In most cases, men who have had a penectomy can still have an orgasm. However, it may be harder to reach orgasm because most nerve endings are located in the glans, or head of the penis, which is usually removed.

However, mental stimulation and touch to the skin around the genital area may also be able to trigger an orgasm.

6. How do you use the bathroom?

After removing the penis, the surgeon tries to reconstruct the urethra so that urine can leave the body in a similar way as before, without major changes to daily life.

However, when the entire penis needs to be removed, the urethral opening may be moved to an area below the testicles. In these cases, the person usually needs to urinate while sitting on the toilet, for example.