very modern medicine

All Your Penis-Transplant Questions, Answered

Frontiers in transplants.
Frontiers in transplants. Photo: Martin J Cook/Getty Images

Last month, doctors at the Cleveland Clinic announced a pilot program to perform ten uterine transplants in women who were born without a uterus or whose wombs have abnormalities. Now, surgeons at Johns Hopkins say they’re ready to complete the first penis transplant in the United States on a wounded vet — after finding a deceased donor, of course.

The New York Times reports that close to 1,400 military servicemen have suffered genital wounds, losing all or part of their penises or testicles, in Afghanistan or Iraq between 2001 and 2013. Nearly all of them were under 35 and were injured by improvised explosive devices, or IEDs. These hidden, stigmatized injuries are a blow to the psyche. As Dr. W. P. Andrew Lee, the chairman of plastic and reconstructive surgery at Johns Hopkins, told the Times, “I think one would agree it is as devastating as anything that our wounded warriors suffer, for a young man to come home in his early 20s with the pelvic area completely destroyed.”

Penis transplants are considered an experimental procedure and there are only two on record: a failed one in China from 2006 and a successful procedure done in South Africa last year. Johns Hopkins will perform 60 transplants on vets to determine if the surgery should become a standard treatment. A Johns Hopkins bioethicist explained that the operation won’t be offered to transgender men but if it proves successful, it will certainly spark a debate in the medical community.

The procedure goes like this: Doctors remove a penis from a deceased donor (with consent from the family) then connect blood vessels, nerves, and the urethra under a microscope. Surgeons insert a catheter that remains in place for a few weeks. Recipients could regain full sexual function in a few months after their nerves grow into the transplant, but it’s not a guarantee. Fathering children could be a “realistic goal” for some, but since only the penis is transplanted, men who’ve lost their testicles will not be able to have biological children. Regardless, recipients would need to take immune-suppressing anti-rejection drugs for the rest of their lives.

Transplants aren’t perfect, but they seem to be better than the other option currently available: a forearm flap. This is a grafting procedure where surgeons take muscle and skin from the patient’s forearm to create a penis. But an implant is needed to have an erection and the implants can cause infection or come out. (Researchers are developing lab-grown penises created from a patient’s own penile cells, but they’re still years away from testing in humans.)

The South African patient who received a transplant last year had his penis amputated after a botched circumcision. If his experience is any indication, transplants work really well: He was able to impregnate his girlfriend less than six months later and recently became a father.