(742) Bridging Inequities in Men’s Sexual Health: A Nationwide Evaluation of Penile Reconstruction Access in Brazil

Introduction Brazil has one of the highest global rates of penectomy, primarily due to penile cancer. Despite this significant public health burden, access to erectile function restoration surgeries such as neophallus creation and penile replantation within the Brazilian Unified Health System (SUS) remains scarce and unevenly distributed. These disparities reflect structural and regional inequalities in the country’s healthcare system and highlight the urgent need for equitable access to sexual health and reconstructive care. Objective This study aimed to analyze regional disparities in access to erectile function restoration surgeries within the SUS from 2015 to 2024, assessing their availability, distribution, and temporal trends in the context of Brazil’s high incidence of penectomy. Methods This retrospective study used data from the Hospital Information System of SUS (SIH/SUS). Hospitalization rates per 100,000 inhabitants for penectomy, neophallus creation, and penile replantation were analyzed across five regions. Descriptive statistics were expressed as mean (standard deviation), regional differences were tested with ANOVA, and temporal trends were assessed using joinpoint regression to estimate the annual percentage change (APC) (p<0.05). Results Penectomy rates were highest in the South [0.93 (0.18)] and Northeast [0.86 (0.17)] and lowest in the Center-West [0.60 (0.15)] (ANOVA, p<0.05; APC = +2.3% in the South, +30.1% in the Northeast, and +25.2% in the Center-West). For neophallus creation, variation was greater (ANOVA, p<0.001), with the highest rates in the South [2.13 (0.57)] and Southeast [1.35 (0.27)] and the lowest in the North [0.80 (0.26)] and Northeast [0.76 (0.23)]. Trends accelerated after 2020, mainly in the North (+17.4%), Northeast (+30.1%), and Center-West (+25.2%). Penile replantation showed the greatest disparity (ANOVA, p<0.001), concentrated in the Southeast [0.56 (0.16)] and South [0.28 (0.07)], and lowest in the North [0.06 (0.04)], Northeast [0.14 (0.06)], and Center-West [0.05 (0.04)]. Trends followed a U-shaped pattern, with declines until 2020 and sharp increases after 2022, especially in the North (+91.9%) and Northeast (+67.1%). Conclusions Penile cancer imposes a disproportionate burden of penectomy in Brazil, especially in the North and Northeast, where access to neophallus creation and penile replantation is limited. Most reconstructive procedures occur in the South and Southeast, revealing a mismatch between disease burden and treatment availability. The U-shaped trends likely reflect the COVID-19 pandemic’s disruption of surgical care and resulting backlog. National strategies are needed to improve early diagnosis, referral, and equitable access to reconstructive procedures, ensuring survival with dignity and quality of life. Disclosure No