News Science

Johns Hopkins Set to Begin Penis Transplant Program

Martha Kempner

Johns Hopkins University School of Medicine announced plans to offer 60 penis transplants to troops wounded in battle. To date, there has only been one successful penis transplant.

Officials from the Baltimore-based Johns Hopkins University School of Medicine said that within the next year it will begin offering penis transplants, specifically for wounded soldiers. The surgery will use an organ from a deceased donor and doctors believe that within months, the patients should start to regain urinary function, sensation, and ultimately sexual function.

The surgery is experimental. To date, there has been one successful penile transplant—a 21-year-old man in South Africa who lost his penis following a ritual circumcision, as Rewire reported. Doctors in China have attempted a penis transplant, but that surgery was not successful.

Doctors at Johns Hopkins will attempt 60 such surgeries and monitor the results so the university can decide if it will become a routinely available option. The risks of such surgery are similar to those in any transplant, including blood loss and infection. Recipients will have to continually take anti-rejection drugs. There is concern that these drugs increase the risk of cancer.

But the benefits can be enormous. Between 2001 and 2013, 1,367 military service men in Iraq and Afghanistan suffered wounds to their genitals. Some lost all or part of their penises or testicles. The average age of the men at the time of their injury was 24, and most were injured by improvised explosive devices (IEDs).

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Those who work with wounded soldiers say genital injuries can be among the most difficult for men to handle. Scott Skiles, a social work supervisor at the Veterans Affairs Palo Alto Health Care System, told the New York Times that his young male patients would rather lose both their legs than their genitals. Other providers told the Times that the first thing many patients ask when they wake up after being wounded is whether their genitals are intact.

“You put into context that these are usually young men who perhaps haven’t had a chance to start a family. A lot of time masculinity has a lot to do with the perception of themselves,” Carisa Cooney, assistant professor of plastic and reconstructive surgery at Johns Hopkins, told CNN. “And to have injury to the genitalia can be devastating to their identity and to their relationships back home.”

Johns Hopkins and the Bob Woodruff Foundation, an organization that aids injured veterans, convened a conference last year to help better understand the issues that come with genital injuries. Jeffrey Kahn, a bioethicist, attended the conference and told the New York Times that soldiers’ wives reported on how devastating the injury was to their husbands’ sense of identity. The men were silent about their wounds.

The Johns Hopkins team is looking for young donors to increase the chance of sexual functioning, and will seek permission from their families, as they believe that some of those willing to donate their loved ones’ hearts, lungs, and livers will nonetheless be uncomfortable donating a penis.

During the surgery, doctors expect to connect four small arteries and two veins under a microscope and will attach at least two nerves, which should provide some sensation. Though patients are expected to recover from the surgery in four to six weeks, it could take a good while longer for them to regain sensation.

Dr. W.P. Andrew Lee, who is leading the surgical team, says that once nerves are connected they need time to grow to the end of the organ. In hands this takes a few months, in arms it can take a year, Lee told CNN. There have not been enough surgeries performed to know how long it will take with penises, but it may have most to do with the size of the donor organ, as nerves usually grow at a rate of about an inch per month.

One concern is what is known as “psychological rejection” of the new body part. The fear is that men and their partners will not be able to get past the idea that this is someone else’s penis. This kind of rejection was reported when the recipient in China asked to have the new organ removed just weeks after surgery.

Lee and his team suspect something else happened in that case and point to photographs of dead skin that suggest there was poor blood flow to the new penis. One doctor on the team compared it to hand transplants, and said that all of the patients he has worked with have immediately accepted the new hand as a part of their body.

The doctors at Johns Hopkins said that transplants are a significantly better option than creating a penis out of patients’ other body parts, which is what is often done for transgender men.

Penises created in the operating room cannot become erect without implants, which have been known to move, come out, or cause infection. For now, transplants are limited to those who have lost penises, but someday the surgery may be offered to transgender individuals.

In the meantime, Lee is hoping potential recipients have realistic expectations. It is unlikely that they will see a full return of the function or sensation that they had before their injuries. One thing that many will likely be able to do, however, is father children, if their testicles remain intact and functional. The South African patient did just that last year.

News Sexual Health

Surgeons Announce the First Successful Penis Transplant

Martha Kempner

A 21-year-old man now has full urinary and reproductive function in a donor penis that was transplanted in December, making this the first successful surgery of its kind.

Surgeons in South Africa announced last week that a penis transplant surgery performed in December had been successful, saying that the patient now had complete urinary and reproductive functionality.

Though not the first attempt at transplanting a donor penis, according to the physicians involved, this is the first time it has been successful. They believe it marks a turning point in helping men who have lost their penises.

The patient, an unidentified 21-year-old, lost his penis three years ago. Doctors were forced to amputate it in order to save the young man’s life when he developed severe complications following a ritual circumcision. The transplant used a penis from an organ donor, whose family had also donated his heart, lungs, kidneys, liver, skin, and corneas to medicine after his death.

It was attached to the recipient during a nine-hour surgery using microsurgical techniques originally developed for the first facial transplant surgery. Like recipients of other organs, this young man will have to take anti-rejection drugs for the rest of his life.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Doctors expected full function of the penis—both urinary and reproductive—to take about two years, but were surprised to find that it happened far sooner than expected. Professor Frank Graewe, head of plastic reconstructive surgery at Stellenbosch University and a member of the surgical team, said in a press release that the surgery marked a “massive breakthrough.”

“We’ve proved that it can be done. We can give someone an organ that is just as good as the one that he had,” Graewe said.

André Van De Merwe, who led the team of surgeons during the transplant, said in a press release that these techniques could be useful throughout the country.

“There is a greater need in South Africa for this type of procedure than elsewhere in the world, as many young men lose their penises every year due to complications from traditional circumcision,” he said. “This is a very serious situation. For a young man of 18 or 19 years, the loss of his penis can be deeply traumatic. He doesn’t necessarily have the psychological capability to process this. There are even reports of suicide among these young men.”

Some experts warn that we should proceed with cautious optimism. A 2006 attempt at a penile transplant by doctors in China ended with the new organ being removed when the patient suffered severe psychological stress. John Robinson, professor of psychiatry and surgery at Howard University, told CNN, “The anxiety of waiting for a transplant creates a lot of anxiety and tension. Once you get the transplant, the anxiety of rejection keeps people pretty nervous.”

Anthony Atala, director of the Wake Forest Institute for Regenerative Medicine, told CNN that while helping men regain their function is a good thing, “it’ll be important to have a follow-up to ensure that we don’t have what happened in China.”

The doctors in South Africa are planning to give nine more men—all of whom lost their penises after botched ritual circumcisions—transplanted penises as part of this initial feasibility study. They believe that one day this surgery could help men who have lost their penises to cancer or even those who have severe erectile dysfunction.

Netwerk24 in Capetown reports that since the news broke of this success, the doctors have been inundated with requests.

Commentary Sexual Health

Easing Penis Anxiety in the Age of Bing and Google

Martha Kempner

A New York Times writer recently found that users identifying as men asked more questions of search engines about their penises than about their lungs, livers, feet, ears, noses, throats, and brains combined.

In a recent piece for the New York Timeseconomist Seth Stephens-Davidowitz argues that relying on classic research methods like surveys to determine humans’ typical sexual behavior may be inaccurate—because people lie in order to look good, even to scientists. Instead, he suggests a new place for us to look for insights on what people are really thinking, feeling, and maybe even doing: search engines, where people are far less likely to fib in their search for help. Of course, as Stephens-Davidowitz acknowledges, Google data is a small sample of what people are thinking, and it is suggestive rather than definitive. Still, his findings offer an unmistakable window into Americans’ psyche around sexuality.

Unfortunately, one thing is especially clear. People are still really worried about their own and their partners’ bodies—mostly, what constitutes “normal” in a world full of misinformation and unrealistic media portrayals. In this two-part series, we’ll remind readers that there’s no need to turn to Bing or Google; genitalia come in lots of different shapes, sizes, and scents that fall into the category of “perfectly normal.”

Part One will focus on typical penis size and girth, evidently the biggest concern many individuals seem to have when it comes to sex and their bodies. In fact, Stephens-Davidowitz found that users identifying as men asked more questions about their penises than about their lungs, livers, feet, ears, noses, throats, and brains combined.

Most Aren’t That Big

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

As we said, men want to know how big penises typically are and how to make them bigger. Oddly, some individuals asked Google how big their own penis was, which Stephens-Davidowitz notes is a question better asked of a ruler. We can’t replace a ruler either, but we can tell you what the research says about most penises.

The most recent study comes from researchers at Indiana University who surveyed 1,661 men and asked each to measure both the length and girth (which can also be thought of as the width or circumference) of his penis when erect. As Rewire reported when the study was released in 2013, “The largest penis in the survey measured in at 10.2 inches long, while the smallest was 1.6 inches. Most fell firmly in between, with the average penis measuring 5.6 inches in length and 4.8 inches in girth.”

This is similar to the results of prior research. A 1996 study, for example, found that the mean length of flaccid penises was about 3.5 inches; the average erect penis was about 5.1 inches long. And, just like in the Indiana study, the mean circumference of the erect penis was 4.8 inches. Two-thirds of the men studied were within one inch of these measurements. Interestingly, this study found no correlation between the relative sizes of the flaccid and erect states, which means catching a glimpse of someone in the bathroom or locker room tells you nothing about what they look like in the bedroom.

Characteristics such as race or sexual orientation are also not good predictors of penis size. You know what else isn’t a good predictor? The size of someone’s feet—turns out that’s just an old wives’ tale. A study of 104 men in London found no statistically significant correlation between penis length and shoe size.

There is a correlation between height and penis size. A few studies have found that taller people tend to have longer penises. And here’s a really odd one: At least two studies have found a relationship between the length of someone’s index finger and penis.

But Men Are Worried

Surveys suggest that men who are shorter and heavier tend to think they have smaller penises (regardless of actual size), while those who are taller and thinner give their member a higher estimation. There’s even one study among men who have sex with men that suggests those who perceive their penises to be smaller than average have poorer sexual health outcomes, which could be a result of riskier sexual behaviors. Such results suggest that perception of penis size is part of a man’s overall body image—that the pressure to conform to a certain “ideal” of height and weight extends to genitalia size as well, possibly as a result of a porn culture that overwhelmingly shows large penises.

And Stephens-Davidowitz points out that Google searches show men think about these issues more than we as a society might realize. He writes: “We do not often talk about male body insecurity. And while it is true that overall interest in personal appearance skews female, it is not as lopsided as stereotypes would suggest.” In fact, his analysis of Google AdWords found that interest in “beauty and fitness” is 42 percent male; “weight loss” is 33 percent male; and “cosmetic surgery” is 39 percent male. Obviously, some of these searches could have been done for a wife or girlfriend, but probably not all of them. For example, 20 percent of “how-to” searches related to breasts asked, “How to get rid of man breasts.”  

Speaking of surgery, it’s worth noting that surgery is the only way to actually increase penis size, no matter what late-night commercials and tubes of cream might say. Penile implants, however, require serious surgery, which cuts the suspensory ligament and is followed by weeks of traction that includes hanging weights on the penis. This results in added length, but only in the flaccid state. And attempts to add girth have even more problems, often resulting in uneven distribution of the added fat tissue, which can have an overall lumpy effect. One study found that most men who have the procedure are not happy with the results.

Bigger Does Not Equal Better

The real question that Stephens-Davidowitz’s research should make us ask—maybe not Google, but definitely ourselves—is “why do we care so much about size?” That bigger penises are synonymous with better penises isn’t all that surprising, given Americans’ overall preference for more, in everything from French fries to McMansions to enormous SUVs. But in reality, size has nothing to do with sexual pleasure, at least not where straight women are concerned.

The issue of how heterosexual women feel about their partner’s penis size has been studied since scientists started studying sex at all. Masters and Johnson, the pioneers of sex research, concluded after watching hundreds of couples have sex that size was irrelevant or a minor factor in women’s sexual pleasure. They reasoned that since the vagina stretches only as much as it needs to, it shapes to the size of the penis inserted within it rather than having a specific requirement.

More recent research suggests that most heterosexual women (85 percent) are happy with their partner’s penis size and attributes, and only 14 percent wanted something bigger. Other studies have shown that when women do want something larger, it is usually additional girth they are looking for, not length.

That said, Stephens-Davidowitz’s research shows we may have it all backwards—more than 40 percent of complaints about partners’ penis size on Google was that it was too big, not too small. This makes sense as a large penis can stretch a vagina to the point of discomfort, and can also bump against the cervix.

Unfortunately, there is not a lot of research as to whether, or to what extent, the size of a partner’s penis matters among men who have sex with men.

Easing Anxiety

Overall, it’s just important to remember that penises tend to be smaller than we think, or at least smaller than the porn industry would have us believe. And that’s OK. We can also remind individuals that the penis they have is very likely the only penis they’re ever going to have, and that regardless of whether it’s an inch longer or three-quarters of an inch narrower than most, they should really try to enjoy it. Finally, we would suggest that anyone who has a male partner or male partners should recognize how pervasive penis anxiety really is, and try to treat them with empathy and sympathy on the matter.