Penile Cancer and a Partial or Total Penectomy

The American Cancer Society estimates that around 1,500 cases of penile cancer (cancer of the penis) are diagnosed in the U.S. each year. Penile cancer is very rare in North America and Europe but is far much more common in parts of Africa and South America, where it accounts for up to 10 percent of cancers in men.

While some types of penile cancer can be treated with laser or localized surgery, invasive tumors may require a much more drastic procedure known as a penectomy.

Understanding a Penectomy

A penectomy is a type of surgery used to remove either part of the penis (partial penectomy) or all of the penis (total or radical penectomy). It is considered a last resort if all other treatment options have failed.

With a penectomy, the tumor and surrounding penis tissue are removed along with lymph nodes in the groin. The removal of these nodes can prevent the further spread of cancer. Each of the surgeries is approached differently:

• A partial penectomy involves the removal of just the tip or head of the penis. This spares as much of the shaft as possible and allows the man to urinate while standing. In some cases, the doctor will cut the ligament that connects the penis to the pelvis bone to increase the penis' length. A skin graft may also be used to help cover the exposed tissue.
• A total penectomy involves the removal of the entire penis, including the root which extends into the pelvis. With a procedure like this, the urethra must be diverted to a new opening, usually between the scrotum and anus, so that the urine can be expelled from the body. A total penectomy is only done if the tumor goes deeply into the penis or is situated at the base of the penis.

Both surgeries can be distressing to men who often consider the penis an embodiment of masculinity. As such, every effort is made to either avoid the surgery, if viable options exist, or to leave as much of the penis intact as the condition allows.

Sex and Intimacy Following a Partial Penectomy

Even though the most sensitive part of the penis is removed with a partial penectomy, a couple can still enjoy a full sex life. The removal of the head of the penis neither prevents a man from getting an erection nor achieving ejaculation.

The foreshortened size may be emotionally distressing, but it doesn't necessarily interfere with a man's ability to have intercourse. Penetration can often be achieved with little more than two inches (three centimeters) of shaft. If needed, the release of the suspensory ligament can further extend the penis length, while surgery may be used to reconstruct the penis head itself.

Open, supportive communication with your partner is key to returning to a fully functional sex life. Professional counseling from a sex therapist may also help.

Sex and Intimacy Following a Total Penectomy

Men who have undergone a total penectomy often have to rethink the expression of their sexuality. There is no underplaying the fact that it can be a difficult process, complicated by more practical issues such as bladder control.

But this doesn't mean that sex is any less important or something a man has to give up. Through experimentation and open conversation, many men and their partners can achieve an emotionally satisfying sex life.

Even after the penis has been removed, there are incredibly sensitive nerve endings in and around the genital area, the groin, nipples, buttocks, and anus. Exploration of these regions with your hands, tongue, or a vibrator can be sensual and lead to the expression of sex as a form of all-body stimulation rather than just penetration. In some cases, it can improve a sex life by redirecting the focus from the genitals to the tactile and oral intimacy of the body as a whole.

If all else fails, a specialized reconstructive surgery, called a phalloplasty, can be explored. It involves the rebuilding of a penis using muscle or skin to create the internal structure and a flap of skin from the scrotum to cover the organ. The urethra can then able to be redirected to the end of the penis, while a removable plastic rod can be inserted to simulate an erection.

A strap-on phallus prosthesis is also a viable option.