Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study

Abstract

Background It can be argued that individuals in the transgender and gender non-binary (TGNB) community suffer from a similar impact on quality of life in the face of gender dysphoria, with psychosocial and physical consequences. Indications for penile allotransplantation for patients wishing to undergo gender affirmation surgery have yet to be elucidated, but technical lessons for feasibility can be gleaned from penis transplants that have already been performed on cisgender males to date. Methods This study investigates the theoretical feasibility for penile-to-clitoral transplantation, prior penile transplants, and current multidisciplinary gender affirmation healthcare modalities. Results Penile allotransplantation offers a potential solution for individuals in the TGNB community for a more aesthetic penis, improved erectile function without the need of a prosthesis, optimal somatic sensation, and improved urethral outcomes. Conclusion Questions remain about ethics, patient eligibility, and immunosuppressive sequelae. Before these issues are addressed, feasibility of this procedure must be established.

Expanding indications for urogenital transplantation: congenital and oncologic defects, and gender affirmation

“…The question of whether or not penile transplantation has a role to the play in gender affirmation surgery has recently been investigated through several feasibility studies [4,5]. The penis is the quintessential symbol of masculinity, bearing culturally significant associations with standing urination, pubertal growth and maturity, virility, and capacity to sexually satisfy a partner.…”

“…The current literature offers little insight into the feasibility of penile transplantation for genderaffirming surgery. A recent anatomic cadaveric study reviewed surgical considerations for allograft attachment and survival: clitoral spatulation would reduce cross-sectional mismatch with penile corpora, age-related clitoral atrophy may limit clitoral hypertrophy and transplant success, ventral spatulation of a smaller caliber female urethra would facilitate anastomosis to the transplant urethra, most if not all analogous vessels should be anastomosed to maximize transplant perfusion and tumescence, and neurorrhaphy should achieve full sensation as seen in prior cases [4]. More recently, cadaveric simulations of female-to-male penile transplantation offered a technique that diverges from past cases in cis-men [5].…”

“…Although only five penile transplants have been performed globally to date, valuable insights have been gleaned with respect to surgical technique, immunologic management, ethical considerations, and factors predictive of transplant loss [3 && ]. Recent developments include new, evidence-based criteria for penile transplantation [3 && ] and a broader discussion about expanding patient selection, indications and feasibility of penile transplantation for patients such as those seeking gender affirmation surgery [4,5]. This review provides comprehensive, up to date indications for penile transplantation based on the global experience and expert opinion.…”