Last updated July 30, 2025 > [!important] This report was produced by Gemini Deep Research. It is for educational purposes only and should not be considered medical advice. - [[#Introduction]] - [[#Types of Penectomy]] - [[#Pros and Cons of Penectomy for Transgender Individuals]] - [[#Reasons for Choosing Penectomy]] - [[#Surgical Procedure and Recovery]] - [[#Resources and Support Networks]] - [[#Conclusion]] ### Introduction Gender affirmation surgery encompasses a range of surgical procedures that alter an individual's physical appearance and sexual characteristics to better align with their identified gender. These procedures, also known as sex reassignment surgery or gender confirmation surgery, form a significant aspect of medical transition for many transgender individuals. While not all transgender people choose surgical interventions, for those who do, these surgeries can play a crucial role in alleviating gender dysphoria and improving overall well-being. Gender affirmation surgeries include both genital and non-genital procedures, tailored to each individual's specific needs and goals. As transgender identities gain increasing recognition and understanding, expertise in gender affirmation surgery continues to grow. Within the spectrum of gender affirmation surgeries for individuals assigned male at birth, penectomy involves the surgical removal of the penis, either partially or completely. This procedure is primarily sought by transgender women, transfeminine individuals, and nonbinary people who desire penile removal as part of their gender transition. Penectomy can be performed as a standalone procedure or as part of more comprehensive gender-affirming surgical plans. While penectomy is also used to treat penile cancer, in the context of gender affirmation, its primary purpose is to align an individual's physical presentation with their internal gender identity. This alignment can significantly reduce gender dysphoria—the distress experienced when one's assigned sex at birth mismatches their gender identity. For many, penectomy serves as a crucial step toward other feminizing genital surgeries, such as vaginoplasty (creation of a vagina) or vulvoplasty (creation of a vulva). Additionally, nonbinary individuals may choose penectomy as part of gender nullification to achieve a body that aligns with their non-binary identity. When combined with orchiectomy (removal of the testicles), penectomy can also potentially reduce the need for testosterone-blocking medications. The decision to undergo penectomy is therefore often driven by a desire for physical congruence, psychological well-being, and the pursuit of broader gender affirmation goals. ### **Types of Penectomy** Penectomy in the context of gender affirmation surgery encompasses several variations, each with distinct characteristics and implications. **Full Penectomy:** This procedure involves the complete surgical removal of the entire penis, including the root that extends into the pelvis. In cases of total penectomy, the urethra is typically rerouted to an opening in the perineum, the area between the scrotum and the anus. This procedure, known as perineal urethrostomy, requires the individual to sit down to urinate. A significant advantage of full penectomy for those seeking further feminization is that the penile skin is often utilized in subsequent vaginoplasty procedures to construct the vaginal canal. **Partial Penectomy:** This variation involves the removal of only a portion of the penis. Often, enough length is preserved to allow for urination while standing. Partial penectomy might be considered by nonbinary individuals or those who are not planning to undergo vaginoplasty. Depending on the extent of the surgery, some individuals who undergo partial penectomy may still retain some erectile function and the ability to engage in penetrative sexual activity after the healing process is complete. **Penectomy with Orchiectomy:** This combined procedure involves the removal of the penis, either fully or partially, along with one or both testicles. This is frequently performed together as part of feminizing bottom surgery. The removal of the testicles leads to a significant reduction in testosterone production, which can decrease or eliminate the need for androgen-blocking medications and potentially lower the required dosage of estrogen in hormone therapy. In many cases, the scrotal skin is preserved during orchiectomy as it can be used later in vaginoplasty or vulvoplasty procedures. **Penectomy with Scrotectomy:** This involves the surgical removal of the penis, along with the scrotum, the sac that contains the testicles. This combination may be chosen by individuals who do not plan to undergo vaginoplasty or vulvoplasty. Penectomy with scrotectomy is often a component of gender nullification surgery, aiming to create a smooth and gender-neutral appearance in the genital area. **Penectomy with Orchiectomy and Scrotectomy:** This comprehensive procedure involves the removal of the penis, both testicles, and the scrotum. It is often referred to as gender nullification or emasculation and results in a smooth genital area. Similar to total penectomy, the urethra is typically rerouted to the perineum. This combination is often chosen by nonbinary individuals who seek to have neither male nor female genitalia. | | | | | | |---|---|---|---|---| |**Type of Penectomy**|**Description**|**Impact on Urination**|**Impact on Sexual Function**|**Use of Tissue in Future Surgeries**| |Full Penectomy|Complete removal of the entire penis, including the root.|Requires sitting to urinate (perineal urethrostomy).|Eliminates penetrative sex.|Penile skin often used for vaginoplasty.| |Partial Penectomy|Removal of a portion of the penis.|May allow standing urination.|May preserve some erectile function and penetrative sex.|Less tissue available for future surgeries.| |Penectomy with Orchiectomy|Removal of the penis and one or both testicles.|Depends on the type of penectomy.|Depends on the type of penectomy.|Scrotal skin may be preserved for vaginoplasty or vulvoplasty.| |Penectomy with Scrotectomy|Removal of the penis and the scrotum.|Depends on the type of penectomy.|Depends on the type of penectomy.|No scrotal skin available.| |Penectomy with Orchiectomy and Scrotectomy (Nullification)|Removal of the penis, testicles, and scrotum, resulting in a smooth genital area.|Requires sitting to urinate (perineal urethrostomy).|Eliminates penetrative sex.|No penile or scrotal skin available.| ### **Pros and Cons of Penectomy for Transgender Individuals** Undergoing a penectomy as part of gender affirmation carries both potential benefits and drawbacks that individuals must carefully consider. **Pros:** Penectomy offers profound alignment with an individual's gender identity, substantially reducing gender dysphoria. This physical congruence typically results in marked improvements in overall quality of life and mental health. For those planning further feminizing surgeries, penectomy serves as a crucial step. The removed penile skin can be skillfully utilized to construct a vagina (vaginoplasty), labia (labiaplasty), and a clitoris (clitoroplasty). Similarly, the glans of the penis may be repurposed to create a clitoris, while scrotal skin can be employed in vulvoplasty or vaginoplasty procedures. When combined with orchiectomy, penectomy significantly impacts hormone therapy by reducing or eliminating the need for testosterone-blocking medications and potentially allowing for lower estrogen doses, which may reduce side effects associated with long-term hormone therapy. **Cons:** The irreversibility of penectomy is a primary consideration. This permanent alteration requires careful deliberation and thorough understanding of the implications before proceeding. Penectomy also results in significant changes to urination and sexual function. Total penectomy necessitates sitting to urinate due to the creation of a perineal urethrostomy. While partial penectomy may still allow for standing urination depending on the extent of tissue removed. Total penectomy eliminates the possibility of penetrative sexual intercourse, although partial penectomy might preserve this function in some cases. Furthermore, the surgery may alter how an individual experiences sexual arousal and orgasm. Like any surgical procedure, penectomy carries potential risks including infection, excessive bleeding, urinary tract infections, lymphedema, scar tissue formation, and potential narrowing of the urethra or vagina if vaginoplasty is performed later. Patients can expect pain and discomfort during recovery, with risks of nerve damage or loss of sensation. Wound dehiscence (separation of wound edges) is another potential complication. The recovery period presents additional challenges, often involving hospitalization, urinary catheters, surgical drains, prolonged swelling and bruising, and restricted physical activities. If vaginoplasty follows, lifelong vaginal dilation is typically necessary to maintain the depth and patency of the neovagina. While satisfaction rates after gender affirmation surgery are generally high, it's important to acknowledge that regret, though rare, can occur. | | | | |---|---|---| |**Category**|**Specific Point**|**Detailed Explanation**| |**Pros**|Alignment with gender identity and reduction of dysphoria|Significant improvement in quality of life and mental health by aligning physical appearance with gender identity; alleviates distress caused by gender dysphoria.| ||Potential for subsequent feminizing surgeries|Penile skin can be used for vaginoplasty, labiaplasty, and clitoroplasty; glans may be used to create a clitoris; scrotal skin can also be used for vulvoplasty or vaginoplasty.| ||Impact on hormone therapy (when combined with orchiectomy)|Reduces or eliminates the need for testosterone-blocking medications; may allow for lower doses of estrogen; can reduce potential side effects associated with hormone therapy.| |**Cons**|Irreversibility of the surgery|The effects of penectomy are permanent and cannot be reversed; requires careful consideration and informed consent.| ||Changes in urination and sexual function|Total penectomy requires sitting to urinate; partial penectomy may affect the ability to urinate while standing; total penectomy eliminates penetrative sex; may change how one experiences sexual arousal and orgasm.| ||Potential surgical risks and complications|Infection, excessive bleeding, urinary tract infection, lymphedema, scar tissue formation, narrowing of urethra/vagina, pain, nerve damage, wound dehiscence.| ||Recovery period and associated challenges|Hospital stay, urinary catheter, surgical drains, swelling, bruising, time off work, restrictions on activities, potential need for long-term care like vaginal dilation.| ### **Reasons for Choosing Penectomy** The decision to undergo penectomy as part of gender affirmation is multifaceted, driven by a combination of psychological, emotional, and practical considerations. For many transgender individuals, the primary motivation is a strong and persistent sense of gender incongruence, coupled with a deep desire for their physical body to align with their internal gender identity. This misalignment can cause significant distress, known as gender dysphoria, which penectomy aims to alleviate, along with associated feelings of anxiety and depression. By undergoing penectomy, individuals often report feeling more comfortable and authentic in their bodies, leading to improved self-esteem and a more positive body image. This deeply personal decision is often rooted in a fundamental need for psychological well-being and self-acceptance. Personal goals for gender affirmation also play a crucial role. For transgender women and transfeminine individuals, removing the penis is frequently seen as a key step in the process of feminizing their physical appearance. Conversely, for nonbinary individuals, penectomy might be chosen as part of a broader set of procedures aimed at achieving a physical presentation that is gender-neutral or aligns with their specific non-conforming gender identity. The specific goals for gender affirmation are unique to each individual, and penectomy serves different purposes depending on these goals. Furthermore, considerations for future surgical procedures often influence the decision to undergo penectomy. For individuals planning to have a vaginoplasty, penectomy is often a prerequisite, as the skin from the penis is commonly used to construct the vaginal canal. The choice between a full or partial penectomy can also impact the options available for subsequent genital surgeries. Individuals who do not intend to pursue vaginoplasty might opt for penectomy alone or in combination with scrotectomy as a means of achieving gender nullification. It is also worth noting that some individuals may consider phallus-preserving vaginoplasty, a procedure that creates a vagina while retaining the penis. Therefore, the decision regarding penectomy, including the specific type and whether to combine it with other procedures, is often carefully considered within the context of an individual's broader surgical and gender affirmation goals. ### **Surgical Procedure and Recovery** The process of undergoing a penectomy for gender affirmation involves several key stages, from pre-operative preparation to post-operative recovery and long-term considerations. Prior to surgery, individuals undergo a comprehensive pre-operative process. This includes consultation with an experienced gender affirmation surgeon. Medical evaluations ensure the individual is in good health and fit for surgery. Psychological assessments are also crucial, often requiring support letters from mental health professionals specializing in gender identity. These assessments confirm persistent gender dysphoria and the capacity to provide informed consent. Many cases require hormone therapy for approximately 12 months before eligibility. Lifestyle adjustments, such as smoking cessation, are typically recommended. For those planning future vaginoplasty or vulvoplasty, genital area hair removal may be necessary. Fertility preservation discussions are essential, as penectomy and orchiectomy result in permanent infertility. Surgical techniques vary depending on the type of penectomy and whether it combines with other procedures. Generally, surgeons make an incision in the penis and remove it either partially or completely. In total penectomy, the urethra is shortened and typically rerouted to the perineum. With concurrent orchiectomy, testicles are removed through a scrotal incision. If scrotectomy is included, the scrotal sac is removed. During surgery, tissues may be preserved for potential use in future vaginoplasty or vulvoplasty procedures. Finally, incisions are closed with sutures. Immediately following surgery, patients remain under close hospital monitoring. Post-operative care focuses on pain management, infection prevention through wound care and dressing changes, and managing urinary catheters or surgical drains. The typical hospital stay lasts a few days. Initial recovery usually takes several weeks, often 4-6 weeks. During this time, patients must avoid strenuous activities, heavy lifting, and sexual activity to allow proper healing. Swelling and bruising are common and gradually subside over several weeks to months. Regular follow-up appointments with the surgeon monitor recovery progress and address potential complications. Long-term outcomes include permanent changes to urination and sexual function. Ongoing hormone therapy typically maintains feminization. If vaginoplasty follows, lifelong vaginal dilation maintains the depth and patency of the neovagina. Despite these significant changes, studies generally report high satisfaction rates among individuals who undergo gender affirmation surgery, including penectomy. While the potential for regret exists, it remains low. ### **Resources and Support Networks** For individuals considering or undergoing penectomy as part of their gender affirmation journey, access to qualified medical professionals, mental health support, and supportive communities is essential. Finding experienced surgeons and medical professionals specializing in transgender care is a critical first step. Referrals can be obtained from primary care physicians or endocrinologists with expertise in this area. Gender clinics and transgender health centers serve as valuable resources by bringing together multidisciplinary teams of specialists. Professional organizations such as the World Professional Association for Transgender Health (WPATH) maintain directories of qualified providers who adhere to established standards of care. Various LGBTQ+ organizations also offer online directories and resources to help individuals find appropriate medical care. Mental health support and counseling services are integral to the process, both for individuals contemplating penectomy and those recovering from the surgery. Therapists and counselors specializing in gender identity and transition provide guidance, support, and address psychological concerns. Mental health assessments are often required before undergoing surgical procedures like penectomy. These professionals help individuals cope with the emotional and psychological adjustments associated with surgery and recovery. Connecting with support groups and online communities for transgender individuals provides invaluable emotional support and practical advice. Peer support groups offer a safe and understanding space to connect with others who have shared similar experiences. Online forums and communities serve as rich sources of information and emotional support, allowing individuals to connect with others from the comfort of their homes. National and local LGBTQ+ organizations often host support groups and maintain online resources. Building a strong support network is crucial for navigating the challenges and celebrating the milestones of the gender affirmation journey. ### **Conclusion** Penectomy, the surgical removal of the penis, is a significant procedure within the broader context of gender affirmation surgery for transgender women, transfeminine individuals, and nonbinary people. Understanding its variations – full or partial, with or without orchiectomy and/or scrotectomy – along with the associated pros and cons, is crucial for informed decision-making. 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