Everything You'll Ever Need to Know About Penis Transplants

Modern medical science has made us all a little careless about our limbs. Lost a hand chopping a carrot? Who cares! The doctor can get you a replacement. Lost a leg trying to impress people by standing in a fire? So what! Pop over to your local walk-in, and someone will hand you a brand new one for free!

The same goes for internal organs—take English actor and man of loud voice, Brian Blessed, for instance, who after a recent on-stage heart attack had a $38,000 pacemaker installed, which he claimed made him feel like a "million dollar man." Afterwards, he said: "Now I can do anything. I just wish they'd given me another cock. That's what I said to the doctors. They said, 'How are you feeling Brian?' I said, 'Great! Now I'd just like a 20-year-old cock!'"

Turns out Brian's demand wasn't as unrealistic as it sounds. In 2014, a South African doctor was the first to ever successfully transplant a penis that went on to actually work. So what's the latest? Could an aging actor have his penis swapped out for another, younger penis without too much hassle? I spoke to urologist and andrologist Dr. Kostas Konstantinidis to get an update.

VICE: How does—or would—a penis transplant work?
Dr. Kostas Konstantinidis: The penis transplant involves connecting the donor penis to the patient. Only patients who have corpora cavernosa tissue [the male erection mechanism] can have a penis transplant. This means that female patients who are looking to have a sex change operation are not candidates. The surgery itself mainly involves connecting the blood vessels and nerves of the donor penis to the patient.

What problems might you encounter?
The challenge is for the blood vessels to remain unblocked the first few days after the operation, because they're very small. Following a successful penis transplant, the penis should work normally in terms of erections, urination, orgasm, and ejaculation. However, sensation at the penis glans will most likely be compromised. The main problem with penis transplants in comparison to phalloplasty [reconstructing a penis surgically] is that the patient would need to take immunosuppressive drugs for the rest of his life.

Where do the donors come from? Is "penis" something you can check on a donor card?
Donors would need be dead or brain-dead men, as with other types of transplants. There are very strict bio-ethical issues around getting donor organs from living patients. Also, men getting genital re-assignment surgery cannot donate their penises because a number of anatomical parts of the penis are used to construct a vagina.

Why might someone want to get a penis transplant?
There are a number of reasons why a patient might have had a severed penis, such as injury or failed surgery. Also, some men suffer from a condition called true microphalia [a micro-penis]. In the majority of these cases, as well as with female-to-male transgender patients, the treatment is a surgery called phalloplasty. This involves reconstructing a penis with skin and muscle from the patient's thigh or forearm. Sexual function can be restored with a penile prosthetic placed inside.

Have you ever had any purely aesthetic requests for either transplants or any other penis surgery?
Penis transplants are at a very experimental level and only a handful have been attempted. Also, because they require the administration of immunosuppressive drugs and a donor penis, they are unlikely to ever become as common as phalloplasty surgery and should never be performed only for aesthetic reasons. If patients need a larger penis, there are a number of surgical and non-surgical ways to achieve this, which are in fact very straightforward.

Like what?
In all men, a part of the penis extends inside the body and isn't visible. This hidden part is attached to the pubic bone through the so-called suspensory ligaments. Ligamentolysis [surgery] involves cutting some of the penis ligaments, which allows part of the "hidden" penis to move downwards and outside the body. Fat injection is the most widely used technique for penis girth enhancement. For men who aren't good candidates for a full penis enlargement surgery or are unsure about it, it's possible to increase the girth and glans of the penis with the use of a filler called hyaluronic acid. But this is absorbed by the body over time, so it needs to be repeated.

Are there many requests for penis transplants?
There are a few patients requesting penile transplants, but this just isn't offered at the moment. It took the South African team five years of planning to tackle the bio-ethical barriers around performing the operation. It's strictly experimental at the moment, and since an alternative treatment exists that does not require the administration of immunosuppressive drugs—phalloplasty—we doubt that this kind of operation will ever be performed routinely. The more interesting research route, which is still at a very embryonic phase, is around tissue engineering, whereby a penis is grown in a laboratory from a patient's own cells. This route is being explored by Dr. Anthony Atala and has already been successfully achieved with rabbits. Of course, translating that to humans is much more difficult.

If a transplant was successful, would there be full functionality?
Yes, there would be full functionality, but reduced glans sensation.

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