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. The procedure falls into two main categories: a partial penectomy, which removes the tip or a portion of the shaft, and a total (radical) penectomy, which removes the entire penis including its root.
Why a Penectomy Is Performed
The primary reason for a penectomy is penile cancer, specifically squamous cell carcinoma. When cancer extends into the deeper structures of the penis or into the urethra, more conservative treatments like laser therapy or localized excision are no longer sufficient. A partial penectomy is indicated when cancer involves the shaft and can’t be managed with less invasive approaches. The surgeon aims to remove the tumor with a margin of healthy tissue, typically 0.5 to 1 cm, to ensure complete excision.
A total penectomy is reserved for more advanced disease, generally stage T3 or T4 tumors, or cases where removing only part of the penis would leave a remaining stump too short for the person to urinate standing up. It may also be necessary when cancer has failed prior, less aggressive treatments.
Outside of cancer treatment, penectomy is one step in penile inversion vaginoplasty, a gender-affirming surgical procedure. In that context, the penile tissue is repurposed: the skin is used to line a newly created vaginal canal, and nerve-bearing tissue from the glans is preserved to construct a clitoris.
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 urethra (the tube you urinate through) is shortened and reattached to the skin at the new tip, creating a functional opening. In some cases, a skin graft taken from the thigh is used to reconstruct a new glans. The remaining penis is typically long enough for the person to direct their urine stream while standing, though this depends on how much tissue was removed.
A total penectomy removes the entire organ, including the three masses of erectile tissue that form its root and anchor it to the pelvis. Because there is no remaining shaft, the surgeon reroutes the urethra to a new opening between the legs, called a perineal urethrostomy. This allows urine to exit the body, but only while sitting down. Studies show patients generally experience significant improvement in urinary function after this reconstruction, and complications like narrowing of the new opening or fistulas are uncommon.
What Recovery Looks Like
The surgery itself is substantial. For a total penectomy with urinary reconstruction, the median operating time is roughly 170 minutes. A catheter is placed during surgery to protect the new urinary opening while it heals. After a total penectomy, adjusting to seated urination is one of the most immediate practical changes. Many patients report feeling relief once they can urinate comfortably again, particularly those who had difficulty before surgery due to the tumor blocking or distorting the urethra.
Wound-related complications can include infection, slow healing, or (rarely) the wound edges separating. When lymph node removal is also performed in the groin, which is common in penile cancer surgery, complication rates climb significantly. Lymphatic fluid buildup, swelling in the legs, and drainage issues from the groin incisions affect a large proportion of patients undergoing that additional procedure.
Sexual Function After Surgery
Sexual function is affected by both types of penectomy, though the degree varies. After a partial penectomy, erections are still physically possible in most cases. One study of 68 patients found that 79% reported no decline in their ability to get spontaneous erections or achieve penetration, and 75% recovered the ability to orgasm. A separate study of 18 patients with a median remaining penile length of about 4 cm found that roughly 56% reported erections adequate for intercourse.
Among those who stopped having sex after partial penectomy, half cited shame about the smaller size and loss of the glans as the primary reason, not a physical inability to perform. A prospective study of 43 patients confirmed that sexual function scores dropped significantly after surgery. Age and anxiety were the strongest negative predictors of sexual outcomes, while the length of the remaining penis was the strongest positive one. In practical terms, younger patients with less tissue removed and lower anxiety levels had the best sexual outcomes.
After a total penectomy, penetrative intercourse is no longer possible. Other forms of sexual intimacy and pleasure may still be an option, but this requires significant adjustment and support.
Psychological and Emotional Effects
The psychological impact of penectomy is profound and well documented. Patients report fears of mutilation, loss of sexual pleasure, and concerns about what their diagnosis and altered body mean for their relationships and families. Self-image and self-esteem take a measurable hit. In one study, two-thirds of patients who underwent partial penectomy reported reduced overall life satisfaction after surgery.
These emotional effects are not purely about sex. Cosmetic appearance, changes in how you urinate, and the underlying cancer diagnosis all contribute. The feeling of shame many men describe can be isolating, and it often compounds the physical limitations of surgery. Research consistently identifies encouragement from partners and family as the factor patients say helped them most in coping with these changes. Pre-surgical counseling that sets realistic expectations about body changes, sexual function, and urinary adjustments can make a meaningful difference in how patients adapt in the months that follow.