Tissue from gender-affirming genital surgery as a model for human penile physiology research: promise, ethics, and scientific duty. A gift from transgender women to the science of male sexuality

Understanding human erectile tissue and tunical remodeling remains one of the enduring challenges in sexual medicine. Despite the high prevalence of erectile dysfunction (ED), no major therapeutic innovation has emerged since the introduction of phosphodiesterase type 5 (PDE5) inhibitors more than two decades ago. The fundamental mechanisms underlying erectile function remain incompletely understood, and many recent insights still rely on animal models to explore and validate emerging physiological hypotheses—even in leading high-impact journals.1 Access to functional human penile tissue remains rare. Most studies have analyzed samples obtained during penile implant procedures, typically performed in cases of severe ED refractory to both pharmacological and mechanical therapies, where structural preservation of the corpora cavernosa is often compromised. Similarly, Peyronie’s disease research is constrained by limited access to well-characterized human tunical tissue, and robust human tunica albuginea models remain scarce. Accordingly, there is an urgent need for new, well-characterized human models to study penile tissue structure and function.