BALTIMORE, Dec. 7 (UPI) -- Doctors at Johns Hopkins University have received approval to perform penis transplants on 60 veterans who were injured during the last decade and a half of war in Iraq and Afghanistan.
The first one may happen within months, depending on doctors' ability to find a donor, which requires the permission of a deceased man's family.
While a penis is not a requirement for survival, doctors say that for man to return from war with genital damage can have more far-reaching effects because of the sense of identity men associate with their penis.
The transplants will be the first in the United States; however, they would not be the first in the world. The first successful transplant, completed in South Africa in March, led to the man impregnating his girlfriend in September -- which is about as successful as you can get.
Just under 1,400 men, nearly all of whom are under 35, who served in Iraq or Afghanistan suffered wounds due to improvised explosive devices, losing all or part of their penises and testicles. Genital damage is not something one can see, such as a missing limb, but the pain of the hidden wound goes deeper because of stigma and embarrassment.
"These genitourinary injuries are not things we hear about or read about very often," Dr. W. P. Andrew Lee, chairman of plastic and reconstructive surgery at Johns Hopkins, told the New York Times. "I think one would agree it is as devastating as anything that our wounded warriors suffer, for a young man to come home in his early 20s with the pelvic area completely destroyed."
Once an organ donor has been located and permission given for the transplant, doctors will carefully reconnect blood vessels and nerves under a microscope. Over the course of several months, as with the man in South Africa, urinary function, sensation, and the ability to have sex will slowly return.
A biological penis transplant is preferable to a graft and reconstruction by doctors because, while the reconstructed penis looks like a real one, feeling does not work the same way, an implant is needed in order to have an erection, and sometimes those implants can break, doctors said.
Lee said doctors will only transplant the penis, not the testes, so a recipient will either be able to become a genetic father or won't be able to have biological children.
The transplant alone, however, is meaningful enough because of the lifelong stigma that may come with losing one's genitals -- regardless of whether it happened while defending the country as a member of the armed forces.
Sgt. First Class Aaron Causey, who lost both legs, one testicle and part of the other from an I.E.D. while in Afghanistan with the U.S. Army in 2011, told the Times the testicular damage was the most troubling of his injuries.
"I don't care who you are -- military, civilian, anything -- you have an injury like this, it's more than just a physical injury," he said.