When a man has cancer of the penis or of the bottom end of the urethra, the best treatment may be amputation of part or all of the penis. These operations are rare, but they can have a devastating effect on a man's self-image and his sex life. If cancer of the penis is diagnosed early, local radiation or chemotherapy creams can sometimes be used to treat it. These treatments often have little effect on sexual pleasure and function. More commonly, however, the only way to stop the cancer is to remove part or all of the penis.

Partial penectomy removes only the end of the penis. The surgeon leaves enough of the shaft to allow the man to direct his stream of urine away from his body.

Men are usually surprised to learn that a satisfying sex life is possible after partial penectomy. The remaining shaft of the penis still becomes erect with excitement. 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 have normal ejaculation. His partner also can still enjoy intercourse and often reach orgasm.

If the shaft cannot be saved, the man must have a total penectomy. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for the urethra (tube from the bladder) between the man's scrotum (sac for the testicles) and his anus. The man can still control his urination, because the "on-off" valve in the urethra is above the level of the penis.

Some men give up on sex after total penectomy. Since cancer of the penis is most common in elderly men, many have already stopped sexual activity because of other health problems. 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.

He can help his partner reach orgasm by genital caressing with his fingers, by oral sex, or by stimulation with a vibrator. The activity some couples show after total penectomy can give hope to those coping with lesser changes in their sex lives.