Doctors have performed the first penis transplant in the U.S.

Don’t giggle: Penis transplants are no joke. The complex, basically uncharted surgery carries immense physical and psychological risks. Until this month, it had been performed only twice worldwide, and one of those patients asked doctors to remove the organ a few days into his recovery.

The New York Times reports that a Massachusetts man named Thomas Manning, 64, has received a penis from a deceased donor and become the third penile transplant patient in history – the first of his kind in the United States. The 15-hour surgery performed at Massachusetts General on May 8 is intended to restore a sense of self and sexual functionality to individuals with traumatic injuries or amputations. Manning should have normal urinary function within a few weeks, and could regain sexual function in weeks or months.

In South Africa, where the first successful surgery was performed (and resulted in a healthy baby last year), surgeons found a large pool of potential recipients who had been injured by a common form of ritual adult circumcision. In the United States, it’s presumed that soldiers – increasingly suffering from devastating genital injuries in explosions – will be the main patient base. Johns Hopkins University had announced intentions to perform the country’s first surgery on a soldier this year and has a long list of veterans waiting for the procedure.

Manning isn’t a soldier – he lost most of his penis to cancer several years ago. Curtis L. Cetrulo, head of the Mass General surgical team that performed the procedure, said that his group will avoid veterans as a patient base until their techniques are perfected. The Defense Department, he reportedly said in an email, “does not like to have wounded warriors undergo unproven techniques – i.e., they do not want them to be ‘guinea pigs,’ as they have already sacrificed so much.”

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As the technique continues to be perfected, it could even be used to give transgender males more natural urinary and sexual function. But both the teams from Mass General and Johns Hopkins have cautioned that this won’t be attempted until the surgery has proved safe and effective for injured cisgender men.

“Today I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries, particularly for our service members who put their lives on the line and suffer serious damage as a result,” Manning wrote in a statement. “In sharing this success with all of you, it’s my hope we can usher in a bright future for this type of transplantation.”

At a press conference on Monday, Cetrulo said that the undertaking – which was preceded by three and a half years of research and practice – was “a huge group effort” and that he was “cautiously optimistic” about Manning’s results.

“We hope that this will be a common part of reconstructive surgery going forward,” Cetrulo said.

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Manning is doing well, but the medical team’s work is far from over: As with any organ transplant, the recipient faces a potentially life-long regimen of drugs designed to keep his body from rejecting the donation as a foreign object. Penis transplants carry an added psychological risk, as well: What would have been the first successful penis transplant – a technically successful operation performed in China – ended with the recipient asking doctors to remove the organ because of his discomfort with the unfamiliar body part.

Doctors in the United States have also been cautious about the effect these surgeries might have on organ donation. Although non-life-saving organs are strictly opt-in – even for registered organ donors – requiring the explicit consent of living family members, researchers from Johns Hopkins had worried that a misunderstanding of the practice might keep people from donating any organs at all. Some researchers are working on creating lab-grown penises, which would theoretically have a much lower likelihood of rejection and carry less stigma than organs from deceased donors.

The country’s first uterine transplant, which would allow women without uteruses to carry a baby to term (and has done so already in Sweden), took place at the Cleveland Clinic earlier this year. But the success was short-lived. Just days after going public, the recipient of the transplant suffered complications and had to have the organ removed.