Penectomy is a surgical procedure done to remove all or part of the penis. This procedure is normally used to treat penile cancer. Penile cancer is a collection of cancerous cells either inside or on the surface tissue of the penis.

Removing the penis is a medical procedure that isn’t undertaken lightly because it has both physical and psychological consequences. Doctors may recommend the procedure if your situation warrants it. Although it’s mostly used if you have penile cancer, in rare cases it might be recommended if you have severe penile trauma.

Surgical procedures
If penectomy is recommended, the surgical procedure can involve different methods. It can be total or partial and may involve additional surgical procedures.

Total penectomy involves the removal of your entire penis. In this case, doctors will create a new urinary opening in the perineum. The perineum is the section between the scrotum and the anus. This is called perineal urethrostomy.

Partial penectomy involves removing the end of your penis but leaving the shaft intact.

Both surgical procedures may be carried out under either general or spinal anaesthesia. This means that you either sleep throughout the operation or remain awake but totally numb in the area of the surgery. Additional steps that may be necessary include removal of the testicles scrotum, and lymph nodes. Surgery to remove the penis and testicles is known as emasculation, but this is usually done only in the case of very advanced cancers. In some situations, such as the cancer invades deep tissue, it may be necessary to take out some of your lymph nodes.

To check if the sentinel lymph node is affected, doctors will inject a radioactive dye close to the cancer. The sentinel lymph node is the first node to which cancer is likely to spread. When that dye is seen at a lymph node, the lymph node is taken out and evaluated. Depending on the results, if cancer is found, other lymph nodes will also be removed. If no cancer is found, further surgery isn’t necessary.

Testing of the lymph nodes in the groin requires an incision to be made into the groin so the lymph nodes can be extracted for evaluation. Stage one cancer offers various options for treatment. This may include circumcision if tumours are just in the foreskin or a more thorough surgery like:

Mohs surgery

Wide excision

Partial penectomy

Recovery from surgery
After penectomy surgery, whether total or partial, you’ll usually need a short stay in the hospital, normally only one or two nights. It’s possible that a temporary catheter will be fitted to drain your bladder. The doctor will give you directions on how to use and care for your catheter if needed.

If you have a partial penectomy, you would still be able to urinate through the remaining penis while standing up. A total penectomy forms a new urinary opening in the perineum. This will mean that you have to sit down to urinate.

You’ll be given medications to prevent blood clots, infections, and constipation. Your doctor will also give you medication to help manage your pain. Your doctor will also tell you the activities to avoid.

You may need a friend or family member to take care of daily activities initially while you recover. Let the person helping you know what things you are not able to do and what help you need.

Self-care
It’s important to take all your medications as instructed by your doctor. This helps prevent pain, infections and constipation.

You’ll also want to help your lungs recover from the anaesthesia. Your doctor may recommend lung exercises. Deep breathing and relaxation can also aid in maintaining lung health and facilitate drainage of lymphatic fluid. You should perform breathing and lung exercises several times every day for the first week.

Complications of penectomy
Like all surgery, penectomy carries risks. Some of these complications can arise either during surgery or afterwards. They may appear right after or overtime during your recovery period. Some complications can be temporary, but others may be permanent.

Besides risks typically associated with all surgery, such as a reaction to anaesthesia or bleeding too much, there are others associated only with penectomy. These include:

Infection

Chronic pain

Narrowing of the urethra

Blood clots

Being unable to have sexual intercourse

Having to sit while urinating.

Additionally, there is the possibility of lymphedema. This refers to local swelling as a result of blockage in the lymphatic system.

Outlook
Although the cancer may be completely removed, life after surgery may lead to psychological issues. After partial penectomy, full intercourse may be possible for you. The remaining shaft of your penis can still become erect. It normally gains enough length to achieve penetration. Even without the sensitive head, you should be able to reach orgasm and ejaculate.

After total penectomy, full intercourse is not possible but, with effort, you can still achieve pleasure. You reach orgasm through the stimulation of sensitive areas, like the scrotum and the skin behind it.

Feelings of stress, depression, or questioning your identity are understandable. Talking with a counsellor may be helpful for you.

Surgical penis reconstruction may be possible. If this is of interest to you, ask your doctor about it.