Penile cancer may be the one thing in the world I’d never wish on my worst enemy. Not only is it cancer, it’s a cancer that can result in the partial or even total removal of your penis: That’s pretty much every man’s bleakest nightmare.
On the bright side, it’s unlikely that my worst enemy — or any of the men in my life, for that matter — will ever be diagnosed with penile cancer (fingers crossed), since it’s an extremely rare disease: Penile cancer is diagnosed in less than one out of every 100,000 men each year and accounts for less than one percent of cancers in men across the U.S.
Still, my paranoid self is preparing for the worst by learning everything there is to know about it with the help of board-certified urologist Alex Shteynshlyuger.
First, let’s look at what causes the disease. “The exact causes of penile cancer aren’t clear, but being infected with human papillomavirus (HPV) and inflammation resulting from poor hygiene are two suspected causes,” Shteynshlyuger explains. “Men who are circumcised as babies also have a lower risk of developing penile cancer.” The reason for this isn’t entirely clear, but it may be related to what he mentioned about poor hygiene: Circumcised men are less likely to accumulate smegma, and men with less smegma are less likely to develop penile cancer.
Diagnosing penile cancer is made tricky due to the symptoms being similar to those caused by STIs. “The most common symptoms of penile cancer are a hard lump or growth on the penis,” says Shteynshlyuger. “Sometimes this can be mistaken for genital warts. Men often also develop phimosis (an inability to retract the foreskin), or their foreskin adheres to the penis shaft when they develop penile cancer — sometimes there’s a delay in the diagnosis, because the problem is treated as phimosis without realizing that the underlying cause is penile cancer.” Other symptoms may include sores on the tip of the penis, smelly discharge under the foreskin and swollen lymph nodes in the groin area.
While this all sounds gruesome, the five-year survival rate (the percentage of patients who live at least five years after being diagnosed) for penile cancer is encouraging when compared to other forms of cancer: Approximately 85 percent for cancer that’s still confined to the penis; 59 percent for cancer that has spread to nearby tissues or lymph nodes; and 11 percent for cancer that has spread to distant body parts.
Unfortunately, the treatments are truly terrifying. “Penile cancer is typically an aggressive disease,” Shteynshlyuger warns. “The most effective treatment for penile cancer is surgery — sometimes that means a partial penectomy (AKA removal of the penis), and less often that means a complete penectomy. When the disease is more advanced, groin surgery is often necessary to remove the lymph nodes.” Radiation and chemotherapy are also options if you catch the cancer early enough. (If the cancer is found early, it can usually be removed with little or no damage to the penis.)
Naturally, the partial — or worse, entire — removal of the penis is the darkest timeline, which makes recovering from penile cancer a daunting task, both physically and mentally. “Recovering from penile cancer requires a strong support network and physical as well as mental stamina,” Shteynshlyuger emphasizes. “While healing from the actual surgery is relatively quick, emotional and mental healing takes much longer. Depression is common, and help from psychiatrists and psychologists is often necessary to recover from penile cancer.”
The American Cancer Society optimistically explains that a partial penectomy doesn’t necessarily have to ruin your sex life:
“Satisfying intercourse is possible for many, but not all men after partial penectomy. The remaining shaft of the penis can still become erect with arousal. It usually gains enough length to achieve penetration. Although the most sensitive area of the penis (the glans, or ‘head’) is gone, a man can still reach orgasm and ejaculate normally. His partner should also still be able to enjoy intercourse and often reach orgasm.”
Seemingly taking things a step further into the realm of outright fantasy, they even claim that a man can have a fulfilling sex life after the entire removal of the penis:
“If a man is willing to put some effort into his sex life, however, pleasure is possible after total penectomy. He can learn to reach orgasm when sensitive areas such as the scrotum, skin behind the scrotum, and the area surrounding the surgical scars are caressed. Having a sexual fantasy or looking at erotic pictures or stories can also increase excitement.”
“A man can help his partner reach orgasm by caressing the genitals, by oral sex, or by stimulation with a sexual aid such as a vibrator. The activity some couples enjoy after total penectomy can give hope to those coping with fewer changes in their sex lives.”
There’s another, slightly better option at least: Recent scientific advancements have provided a new opportunity for men in need of a new penis. “Theoretically, one can undergo a penile transplant after a penectomy,” Shteynshlyuger explains. “However, penile transplants wouldn’t typically be advisable until four or five years after treatment to ensure that the cancer doesn’t come back — penis transplant also require lifelong use of immunosuppressant medications that can increase the chances of disease recurrence and make it dangerous to provide chemotherapy if necessary. That said, if a patient has been disease free for five years, it would most likely be safe to undergo a penis transplant.”
Alternatively, you could join the small (but proud) group of men with bionic penises. But then again, that comes with its own set of complications.
So for now, simply check your penis every so often, and let your doctor know if something strange is going on down there.