A penectomy is the surgical removal of part or all of the penis. It is most commonly performed to treat penile cancer, though it also plays a role in gender-affirming surgery for transgender women. The procedure comes in two main forms: a partial penectomy, which removes only the affected portion of the penis, and a total penectomy, which removes the entire organ.
Why a Penectomy Is Performed
Penile cancer is the primary reason for this surgery. Even at stage I, when a tumor has grown into deeper tissue of the glans, penile amputation is one of the standard treatment options. At stage II, it becomes the most common approach for controlling the disease locally. Whether the surgery is partial or total depends on where the tumor is and how far it has spread. At stage III, when cancer has reached nearby lymph nodes, a penectomy is typically followed by removal of lymph nodes in the groin on both sides.
If a patient initially received radiation therapy and the cancer returns, penectomy is often the next step. Surgeons aim to remove enough tissue to get clear margins around the tumor. Historically, a 2-centimeter margin of healthy tissue was standard, but current evidence shows that even a margin just over 1 millimeter can be sufficient without affecting long-term cancer outcomes. This shift has allowed more men to keep a greater portion of the penis through partial procedures.
In gender-affirming surgery, penectomy is one component of vaginoplasty for transgender women. During this procedure, the penile tissue is carefully disassembled and repurposed. Penile skin is preserved to line the new vaginal canal, and the sensitive tissue of the glans is used to construct a clitoris. The goals and technique differ significantly from cancer surgery, where the priority is removing all diseased tissue.
Partial vs. Total Penectomy
In a partial penectomy, the surgeon removes the end of the penis while preserving as much of the shaft as possible. The remaining urethra (the tube you urinate through) is rerouted to the tip of the shortened penis, so you can still urinate standing up. A partial procedure also preserves some capacity for erections and sexual activity, though both are affected.
A total penectomy removes the entire penis. Because the urethra no longer has a natural exit point, surgeons create a new opening called a perineal urethrostomy. This is a small, permanent opening in the perineum, the area between the scrotum and the anus. After this procedure, you urinate while sitting down. Research shows that urinary function actually improves after the new opening is created, likely because many patients had obstructed flow from the tumor beforehand. In one study, patients’ urinary symptom scores dropped by more than half after surgery, and their self-rated quality of life related to urination also improved.
Recovery After Surgery
A typical hospital stay lasts up to three days. A catheter remains in place to drain urine for up to two weeks while the surgical site heals. Swelling is common and can persist for several weeks. Beyond the physical healing, the adjustment to a changed body is gradual and ongoing, with many men needing months to adapt to new ways of urinating and managing daily activities.
Sexual Function After Partial Penectomy
Sexual function is significantly reduced after a partial penectomy, but it is not necessarily lost. In a prospective Chinese study of 43 patients, about 49% reported erections reliable enough for intercourse. Another 28% reported erections that were sometimes sufficient. Roughly 23% reported no sexual activity or near-complete loss of erectile function. A separate study found a similar result, with about 56% of patients able to achieve penetration.
Two factors strongly predicted outcomes. Age was negatively linked to erectile function, sexual desire, and overall satisfaction, meaning younger patients fared better. The length of the remaining penis was positively linked to satisfaction during intercourse. Anxiety also played a significant role: higher anxiety scores correlated with worse erectile function, reduced desire, and lower satisfaction. After a total penectomy, penetrative intercourse is no longer possible, though other forms of sexual intimacy remain available.
Psychological and Emotional Impact
The psychological toll of penectomy extends well beyond the operating room. Patients face distress not only from a cancer diagnosis but from the loss of bodily integrity and sexual function. Research shows that anxiety levels in penile cancer patients who undergo surgery tend to be notably higher than in patients undergoing other major urologic operations, even though depression levels are comparable.
Body image changes affect daily life in concrete ways. Survivors report avoiding urinals in public restrooms, choosing stalls instead. Some stop wearing shorts, avoid swimming pools or saunas, and withdraw from social situations where they fear others might notice a physical change. The perceived loss of masculinity can be deeply distressing. In a large database analysis of over 6,000 penile cancer patients, 13 suicides were recorded, all among patients who had undergone surgery. Some patients who did not die by suicide still reported suicidal thoughts linked to changes in their body and identity.
The more extensive the surgery, the greater the impact on quality of life. Studies have found a direct negative correlation between the aggressiveness of the procedure and patients’ self-reported physical functioning and overall health. Yet relationships often prove more resilient than patients expect. Among those who maintained a partnership after surgery, about 59% said their relationship was not worse than before. The type of surgery did not significantly influence relationship outcomes with partners.
One glaring gap stands out: 84% of patients in one survey said they received no help or information on coping with changes in sexual functioning after the procedure. This suggests that the emotional and sexual rehabilitation side of recovery is drastically underserved.
Reconstruction Options
For men who want to rebuild a penis after a total penectomy for cancer, phalloplasty (penile reconstruction) is possible, though it is a complex, multi-stage process. Specialists typically recommend waiting at least one year after the initial surgery with no cancer recurrence before considering reconstruction.
The most common technique uses skin and tissue from the forearm, shaped into a tube-within-a-tube design that includes a new urethra. An alternative uses tissue from the thigh, which leaves a less visible scar at the donor site and allows more flexibility in the size of the reconstructed penis. If the thigh tissue is too bulky, a thinner tissue graft from another site can be used to build the urethra separately.
Reconstruction typically takes two to three staged surgeries. If the patient had a perineal urethrostomy, that opening needs to be reversed and the urethra rerouted so standing urination becomes possible again. An implantable erectile device can be placed at least three months after the previous stage, allowing penetrative intercourse. The published experience is still limited, with only 19 cases of post-cancer phalloplasty recorded in the medical literature, but the results show it is a viable path for men who choose it.