It is difficult to imagine the whole gamut of feelings that a man experiences with the recommendation of doctors to remove the genital organ. Removal of the penis is perceived as a disaster for life. But not everything is so terrible. Today, there are many opportunities to preserve not only health, but also sexual functions in such cases.
Removal of a member, or amputation, is called a penectomy. Technically, it is easier for the surgeon than amputation of a limb or other internal organ. The problem is maintaining the peace of mind of a man. So, a penectomy is an operation to remove the penis in whole or in part.
When it is needed
Amputation is performed for injuries or severe pathologies (oncology) of the penis, as well as for gender changes in transgender people who identify with a woman during body modification.
It is also necessary to remove a member as a result of:
- receiving a man's scalped wounds (detachment of the penis) from an animal bite;
- member injuries from a stroke followed by crushing - then necrotic tissue must be urgently removed;
- thermal burns and frostbite;
- chemical burns.
Fact! Penis cancer is a rare disease, only 7-8 cases per 100 thousand men. And carcinoma in half the cases is associated with HPV type 16 and type 18.
If the penis is not lost and not crushed, you can try to sew it in place, subject to proper preservation. To maintain viability, the detached penis is treated with an antiseptic and placed in a sterile ice pack. During the day, such a penis can be sewn into place in the hospital.
How can an operation be performed?
Ectomy can be performed at any level, be partial (removal of a part of the phallus’s body or its head) and total (complete removal of the penis + testes + scrotum). The operation to remove a penis at any level is considered crippling, the functions of the penis are partially or completely lost. These include: loss of erogenous sensitivity of the head, impossibility of intimacy, erection, urination while standing.
The urination process can still be corrected by suturing the urethral opening in the form of an ellipse at the end of the penis stump. Or create another hole in the crotch area. Partial penectomy, of course, is a more gentle procedure - libido and getting an orgasm are preserved, ejaculation and fertilization are often possible. With the totality of the operation, the man becomes barren.
Penectomy for gender reassignment
Removal of a member without feminizing colpoplasty is also called informally as "nullification." If the patient plans further feminizing vaginoplasty, it makes no sense to separately make a penectomy. The tissues of the penis in such patients create an artificial vagina. With a new urethral canal, such a man can urinate while sitting.
Today, you can correct the floor without removing the tissue of the penis, which allows you to save the orgasm in the future. For this, scrotum tissue is used, of which the vagina and labia are formed.
Penectomy as a punishment
This issue is often addressed in many countries for sex offenders. But there is no reliable information about this.
Types of operations
A penectomy is performed by several methods.
The method of emasculation is the extirpation of the penis in oncology at its 4 stages with deep scrotal metastases. Under anesthesia, the penis and testicles, inguinal lymph nodes are removed. If the pelvic bones are involved, they are partially removed as well. The prognosis depends on the number of lymph nodes involved. Removal of the penis depends on the location of the tumor, because during amputation, an incision is made, capturing healthy tissue by 2 cm.
A scalp amputation surgery is used when the tumor does not extend beyond the tissues of the foreskin. The main requirement for using this type of operation is the preservation of cavernous bodies.
Total amputation and subsequent urethrostomy are performed as follows:
- dissect the skin to the albumen;
- cross the cavernous bodies and impose nodal seams on them to stop bleeding;
- then the urethra is sutured into the skin of the perineum;
- a permanent catheter is inserted into the bladder.
Carcinoma or gangrene
Carcinoma or gangrene of the penis is also an indication for penectomy. The phallus is plentifully supplied with blood, so the operation requires a preliminary stop of blood flow. In this article we will not present a photo of the removal of a member, but it is already clear that this procedure is not easy.
Around the root of the penis, a tourniquet is applied, vascular constriction occurs. A circular incision of the skin is made within the boundaries of healthy tissue by 2 cm. The urethra is separately dissected and intersects 0.5 cm below the amputation site. This piece of skin is needed to sew the urethra to the edges of the skin. Then the cavernous body crosses and a catheter is inserted.
Removal of the head of the penis is carried out with its small tumors (stage T1 and T2). Half of the cases of penis cancer are localized in its head. Carbon dioxide laser ablation or NdiYAG neodymium laser is used for this purpose. Or the destruction of ZnCl2 tissues by Mos. If the neoplasm is localized exclusively in the foreskin, only circumcision is performed (circumcision ), even taking into account relapses.
Penectomy Technique
First, the question of leaving a stump of 2-3 cm for ease of urination is decided. The patient's position is on the back with a large diaper between the legs to absorb organic fluids during surgery, so that it does not get into the anus.
The penis is treated with iodine and put on it or a finger from a glove, or a condom. This is necessary to isolate the tumor tissue from neighboring healthy tissues. The incision is made a little obliquely so that more skin remains at the closure of the stump. Excision proceeds sequentially, with superficial tissues and deep into.
By the way! If the scrotum is not involved in the pathological process, it is not removed.
Having gained access to the spongy body of the penis, the surgeon crosses the urethra in it and forms the primary stump. After suturing the wound, the tourniquet is completely removed from the base. The surgeon dresses the stump with skin of flesh, leaving room for the urethral opening.
Complications after surgery
They are more often distant:
- During an erection, the stump can bleed. In these cases, the stump is altered.
- There may be stenosis of the external opening of the urethra and a weakening of the stream of urine (in such cases, the patient must be trained to walk the urethra himself). Even if the stump is too long after the operation, there is no tragedy in it - over time, it will contract itself.
For full-fledged sexual rehabilitation, prosthetics of the newly created penis are used with modern falloprostheses. There are also methods when they use autobone-skin flaps that are not rejected by the body and are less infected.
After treatment for cancer of the penis, it is necessary to be observed by a urologist for at least 5 years. Five-year patient survival is 70%. The relapse rate after surgery is up to 7%. With timely detection of relapse, the disease is completely curable.
Postoperative Recovery
After any amputation of the penis, the man remains in the hospital until the stitches are removed. During this time, he must be prescribed antibiotics to exclude complications in the form of infection, analgesics in the presence of pain at the amputation site. Phantom pains become characteristic - they are observed with amputation of any external organs.
The patient feels the presence of a penis, which is very painful. These pains, fortunately, are temporary.
From standard recommendations:
- restriction of physical activity;
- restriction of drinking due to pain in urination;
- wearing loose linen;
- prevention of sexual arousal.
Hot baths, saunas and sex are excluded for a minimum of 2 months.
Life after penis amputation
The operation is tolerated quite easily, but the main trauma remains the psychological plan. There is a constant awareness that the main male dignity is no more. Therefore, work with a psychotherapist is required. Sex in some cases is quite possible, because even the stump erects. Over time, you can get advice from the andrologist on how to get an orgasm in the new environment.
Bridle removal
Often there is such a congenital anomaly as a short bridle of the foreskin. It leads to the appearance of sharp pain during an erection and flexion of the head of the penis.
The fact is that a short bridle during an erection is very tight, and tears of the foreskin may appear. The pains are so sharp that they can interrupt intercourse and erection. In addition, in such cases, premature ejaculation occurs. For a man, this is a lot of stress, because there are problems with potency.
The foreskin can also suffer from inflammation (balanoposthitis), the symptoms of which are also painful and can lead to ulcers of the head and the inner part of the foreskin. The operation to remove the frenum of the penis is considered the most correct solution for such problems with potency. The operation itself lasts no more than 30 minutes; local anesthesia is enough for it. Full rehabilitation occurs after 2 weeks.
Bridle Removal Operation
Removal of the frenulum of the penis, or frenulotomy, is recommended for:
- healed frenum tissue;
- pain in the head during intercourse or when the head is exposed;
- frenum tension during sex;
- tears of the flesh and bridle at the same time;
- tilting the head down with an erection.
Operation on the foreskin will significantly increase the length of the frenum and protect it from tears. The essence of the operation is that the bridle is cut across, and then the skin is sutured in the longitudinal direction with thin threads.
Complications after surgery
In the process of any operation, there is always a risk of 2 frequent complications - severe bleeding or infection. There are no large vessels in the foreskin; bleeding is excluded. From infection, the patient receives antibiotic therapy. Locally prescribed cream with an antibiotic, the patient himself applies it during the week of treatment in the hospital.
Frenulotomy is not performed for liver diseases, the presence of inflammation on the phallus, in MPS, for STIs, for HIV infection.