From now until sometime in early 2023, we’ll be writing about gender affirming procedures. We’re starting with bottom surgeries and will end with office visit procedures such as fillers and botox. This week’s surgical procedure is penectomy.
Content advisory: we will be using anatomical terms and discussing surgical procedures in this article and this series. External sites that we link to may contain graphic images.
What is a penectomy?
Penectomy is the partial or complete removal of the penis. As a part of gender affirming healthcare, it can be done alone, as a stage of a process, or simultaneously with other procedures. During this procedure, the urethra will be shortened and moved. Penectcomies are used in gender affirming care and cancer treatment. When a penectomy is done as part of vulvoplasty and vaginoplasty, the glans may be used to create a new clitoris, while other tissues are used for labia and the vaginal canal. When a penectomy is done as a part of nullification (nullectomy/nullo) procedures, the penile nerve bundle may be buried in the mons or removed entirely.
When: Expected Prep and Recovery for Penectomy
Prep for penectomy is similar to other bottom surgeries. The extent of hair removal will depend on aesthetic preferences and if additional procedures are planned, such as vulvoplasty and/or vaginoplasty. If you are a smoker, your surgeon will want you to quit smoking for a couple of months before surgery.
Recovery is also similar to other bottom surgeries. Patients will stay in the hospital for a couple of days post-op. Lifting and activity restrictions will apply for up to 6 or 8 weeks, and significant restrictions will apply for the first month. Activity restrictions may depend on whether or not other procedures were done along with the penectomy. A catheter and surgical drains may be placed.
As with other major surgeries, recovery time may be long, and nutrition, substance use, and stress can impact your healing.
Who: Surgeons Who Offer Penectomy
Penectomy is a common gender affirming procedure, as it is often part of the vulvoplasty and vaginoplasty processes. Many surgeons offer this procedure. Some resources for locating a surgeon include:
- talking to others in the community
- gender care centers at academic institutions such as OSHU, UCSF, UW
- well-known private practices such as MozaicCare, Align Surgical, Crane Center, etc.
- WPATH Provider Directory
- OutCare Health
- The r/TransSurgeries wiki on Reddit
- our gender affirming surgery page
If penectomy is planned as a part of nullification (nullectomy/nullo,) our blog on nullectomy has links to surgeons who offer that set of procedures.
How: Common Surgeon and Insurance Requirements to Access
Like other lower surgeries, you will likely need a letter from a mental health provider for your surgeon and a letter from your surgeon and hormone provider for insurance. Hormone use may not be required for penectomy. If other procedures are planned, such as vaginoplasty, the current WPATH SOC 8 language recommends six months of hormone use unless hormones are not desired or are medically not appropriate. Some policies may require that you document your support and housing plans during recovery.
Why: Some Things to Think About When Choosing Penectomy
Penectomy may change how you have sex and how you experience sexual arousal and orgasm. This, of course, may be exactly what you want. Acting as a penetrative partner during sexual activity is possible after partial penectomy but not without prosthetics (or using other body parts such as your hands) after total penectomy. P.S. – check out our Sex Toys For Trans Folx blog!
If having a biological child is important to you, discuss fertility-preserving options with your doctor, especially if you are also considering orchiectomy.
Penectomy will change how you pee. It will also likely change how your abdominal and pelvic structure sits. Pelvic physical therapy may help you get acquainted with your new alignment.
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