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).
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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.