Missing limbs are a too common, visible war wound, mental repercussions are often discussed, but one injury incurred by nearly 1,400 U.S. service men in the Gulf Wars or Afghanistan is rarely exposed – sexual dysfunction because of injuries to their penis or testicles. These generally young men in their 20s received genitourinary injuries (losses of all or part of their penises or testicles) that left them in shame, depression and facing a future without sex and with urinary problems. But, hope for a bright future could exist if experimental penis transplants, which doctors in the U.S. will first begin attempting to perform on wounded veterans, prove successful.
Doctors at the Johns Hopkins University’s School of Medicine in Baltimore, Maryland, will conduct the first U.S. penis transplant next year. The patient is reported to be a soldier injured by a bomb in Afghanistan. The John Hopkins team have received permission to conduct as many as 60 of the transplants starting next year on veterans with genital injuries.
Genitourinary injuries are not widely talked about. Doctors who treat wounded soldiers report that the first thing many of the men ask about when they regain consciousness is whether their genitals are intact. They want to feel whole again as men. As Dr. W. P. Andrew Lee, Johns Hopkins’ chairman of plastic and reconstructive surgery, noted, “I think one would agree it is as devastating as anything that our wounded warriors suffer, for a young man to come home in his early 20s with the pelvic area completely destroyed.”
To date, other two other experimental penis transplants have taken place in the world with uneven results. One man was in China in 2006, but he asked to have the donor penis removed after he reportedly rejected it psychologically. The second man in South Africa last year was so successful that the man has since conceived a child. (The child is biologically his since his testicles were intact.)
Extensive research and practice surgeries have been conducted on cadavers, since the operation involves connecting several nerves, approximately six veins and arteries, and urinary functionality. The surgery is very complicated. For a transplant to even be possible, the recipient needs to still have certain nerves and blood vessels intact, as well as the patient’s urethra so urine can flow in a normal manner. Besides the physical requirements, the candidate needs to be psychologically ready to accept the new body part, accept the risks, and understand the need to faithfully follow the anti-rejection medicine regimen.
Critics have questioned the idea and estimated $200,000 to $400,000 cost of penis transplants, because they are not life-saving efforts like most other transplants. However, the same could be said about hand or corneal transplants too. However, there are quality of life arguments and psychological reasons too. There is also some concern that families who would agree to a lung or heart donation when a loved one dies may be reluctant to donate the genitals.
The surgery is still highly experimental and doctors will first conduct penis transplants on wounded veterans, but there is hope that it could eventually be performed for gender reassignment surgeries. However, the ethical considerations of organs being used for reassignment versus reparation and the need for more experience with the surgery – initially on the veterans – before any additional efforts can be considered.
Written and edited by Dyanne Weiss
New York Times: Penis Transplants Being Planned to Help Wounded Troops
People: Baltimore Doctors to Perform First Penis Transplant in the U.S. on a Soldier Injured in Afghanistan
New York Magazine: All Your Penis-Transplant Questions, Answered
New York Magazine: Talking to the Doctor Behind the World’s First Successful Penis Transplant
Photo from defenseimagery.mil, public domain