There are options for penis repair after mutilation

The actions of a Southern California woman who allegedly cut off her husband’s penis has horrified men throughout the country, perhaps even the world.

FOR THE RECORD: A previous version of this post mistakenly referred to Osiris when Isis was intended. The sentence as corrected: “Isis was able to collect and reassemble 13 of the pieces, but could not find the penis, which had been eaten by a fish.”

In the midst of divorce proceedings triggered, perhaps, by “inappropriate relationships” on his part, Catherine Kieu Becker drugged her husband’s meal to render him unconscious, tied him to a bed and cut off his penis with a 10-inch kitchen knife, police say. She then put the severed organ in the garbage disposal and turned it on before calling 911.

Surprisingly, penis destruction is not that uncommon an event, and surgeons have developed a variety of techniques to deal with it.

Most news stories about the incident cite the case of Lorena Bobbitt, who cut off the penis of her husband, John, and threw it out of a moving car. That penis was ultimately found and reattached, leading John Bobbitt to a brief career in porn movies. But a cursory search of the Internet suggests that the event is far more common than might be expected.

One of the oldest tales of penile rage involves Osiris, the Egyptian god of the afterlife and the underworld, and his sister/wife Isis, goddess of motherhood and magic. Their brother Set, god of chaos, was jealous of the relationship and killed Osiris, cutting him into 14 pieces that he scattered across Egypt. Isis was able to collect and reassemble 13 of the pieces, but could not find the penis, which had been eaten by a fish. To replace it, she fashioned one out of gold before bringing him back to life. Using the new phallus, the couple conceived Horus, the god of the sky and vengeance.

More recently (1916), Russian revolutionaries lured the monk Grigori Rasputin, confidant of Czarina Alexandra, from his hiding place, poisoned him, shot him, beat him, cut off his penis, tied him up and threw him into an icy river. The penis is claimed to be in a museum of erotica in St. Petersburg.

In 2005, Kim Tran, a 35-year-old woman in Anchorage, Alaska, cut the penis off her 44-year-old boyfriend and attempted to flush it down the toilet. She was angry because he would not leave her aunt, to whom he was married. Utility workers recovered the penis, which was successfully reattached.

Several news reports indicate that Thailand may lead the world in penis slashings, often over disputes about the common custom of men having a second wife. The act is colloquially referred to as “feeding the ducks” because that is apparently a common way of getting rid of the evidence. A 2008 report in the journal Burns indicated that electrical burns are a common cause of penis loss in India, although the report did not address how the injuries occur.

A variety of techniques are available for repair and replacement. If the penis is intact it can be reconnected -- though the surgery is time-consuming and delicate. The first successful case was reported in 1977, involving a mentally disturbed 21-year-old man who cut his organ off with a straight razor because he was obsessed with guilt over his sexual behavior. Surgeons at Massachusetts General Hospital successfully reattached it, restoring full function.

If most of the penis is lost, however, the “gold standard” is taking tissue from elsewhere on the body to reconstruct the organ, said Dr. Gary Alter of UCLA’s Geffen School of Medicine, who is board-certified in both plastic surgery and urology. “You can make something that looks life a penis somewhat, you can have intercourse, but it’s not your own penis,” he said. “Nobody is thrilled because it is not their own penis. The only people who are thrilled are transsexuals who never had one before.”

If reconstruction is not undertaken, or if a delay is necessary, surgeons often reroute the urethra, which carries urine, through a small hole in the scrotum so that the patient can urinate while sitting.

For reconstruction, surgeons most often use tissue from the arm, the back or the lower leg to function as something that looks like a penis, including the nerves and blood vessels. The tissue is formed around an artificial ureter, made from skin. The procedure, which involves several steps and a large team of specialists, involves a delicate reattachment of nerves, blood vessels and tissue. Only a few centers do the procedure, notably Dr. David Gilbert of the Eastern Virginia Graduate School of Medicine in Norfolk, Va.

If the nerves are connected properly, Alter said, the patient may get erogenous sensations, particularly in the head of the penis. But because the arm does not contain the soft, spongy tissue typical of the penis, the patient cannot get an erection. That problem is overcome by implanting, well after the initial repairs have healed, a prosthetic implant, such as a hydraulic pump. Overall, “it’s a long, complicated, expensive procedure,” Alter said. But when it is finished, the patient can get an erection, have intercourse and climax.

If the patient is hairy, electrolysis also needs to be performed to remove hair from the penis. That can be done before or after the surgery.

Hope for the future may come from the work of Dr. Anthony Atala of the Institute for Regenerative Medicine at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. Atala reported in 2009 that he had created a synthetic penis for rabbits. He used smooth muscle cells and endothelial cells such as those that line blood vessels and seeded them onto an artificial scaffolding. The rabbits were able to get an erection, mate with females and sire healthy pups. Human trials of the synthetic organs are still years off, however.