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The Surgeon Restoring Penile Sensation to Men With Spinal Cord Problems

Patients with spinal cord injuries and some birth defects can’t always feel their penises or have orgasms, but plastic surgeon Max Overgoor is on a mission to change that

Dutch plastic surgeon Max Overgoor is a man on a mission. For the better part of a decade, he’s been fine-tuning his groundbreaking TOMAX procedure, a surgical lifeline for men with spinal cord injuries still desperate to feel penile pleasure. In a nutshell, it’s a surgical procedure in which a functional “groin” nerve is connected to the non-functional “penile” nerve to bypass the lower spinal lesion. 

In layman’s terms, that means it’s a pleasure-centric surgery that can grant the gift of orgasms to men who have often never experienced them.

The story of this game-changing procedure begins in the Netherlands, where Overgoor trained as a plastic surgeon. “I was seeing a lot of patients with spina bifida,” he tells me. “Around the age of puberty, they started complaining about a lack of feeling in their genitals.” Eventually, this common complaint sent him down a sex-focused wormhole. “I started looking at the literature, but nobody had found a solution for this problem.”

As Overgoor explains, “Patients with spina bifida or spinal cord injuries don’t have sensation in their penis. Sometimes, they can have an erection and even ejaculate, but they don’t feel anything.” This happens because the spinal cord is a key vehicle through which the body fires neurotransmitters and sparks signals in the brain. It controls sensations like pain and, of course, pleasure. When it’s damaged, the neurotransmitters that create the feelings of horniness and sexual stimulation never make it to your brain.

Because spina bifida is classified as a birth defect, babies born with it don’t know what it’s like to feel sexual pleasure in the first place. But for guys who suffer life-changing spinal-cord injuries, this sudden inability to feel horny can take a huge mental toll. “When you talk to these patients, sexual pleasure and sexuality is one of their major concerns,” Overgoor explains. “Many of them classify it as even more important than being able to walk again.”

Determined to fill some of the hornier gaps in existing science, Overgoor began brainstorming potential solutions. “I finally figured out how to perform a surgery using a groin nerve, which is still intact for patients with a low spinal injury,” he explains. “The nerve to the penis doesn’t work, but the nerve to the groin still does.” 

Soon, he figured out he could “suture the groin nerve to the penile nerve” to essentially reinstate the feeling of sexual pleasure. After a handful of successful trial runs on deceased patients, he convened with medical ethics committees and sourced four living patients. “We knew this was technically feasible, and it turned out that, of these four patients, three of them regained sensation of the glans penis,” he says.

Before long, he had 30 more patients. Years later, he’s now completed the TOMAX procedure on 85 people in total, and he’s traveled the globe teaching the technique to other doctors. There are, however, a few nuances that differentiate feelings of arousal after the TOMAX procedure. “When someone touches the glans penis [after TOMAX], the first sensation that person encounters is in their groin [more generally], which is really strange,” Overgoor explains. “But then, if you look at your penis [while it’s being touched], the plasticity of the brain transforms that feeling to make it seem the sensation is in the penis itself.”

Basically, there’s neurological training involved — patients must actively retrain their brain to associate penile stimulation with penile sensation. Overgoor explains the “results are different for all sorts of people” — around 70 percent will regain the aforementioned pleasure in their groin, and approximately half of this 70 percent will be able to fully retrain their brain to “actually feel the penis.”

For these guys, the self-esteem boost has been huge. “There’s one patient who couldn’t feel his dick sliding in and out of his girlfriend, which made him self-conscious,” Overgoor tells me. But post-TOMAX, his tingly pleasure receptors can sense exactly where his penis is, and exactly what he’s doing with it. Five young patients with spina bifida even managed to experience an orgasm for the first time, and Overgoor says a handful of dudes who knew what it felt like to cum pre-TOMAX believe the procedure has actually amped up their sex lives. “For some people, they get more aroused and cum more easily than before.”

Or as his first U.S. patient, a 19-year-old college student born with spina bifida, puts it: “Before the surgery, I found that sex was very frustrating and unsatisfying. Today, I have a very good sensation. I feel like I gained a body part that I was previously missing.”