The theatrical world of penis envy took an unexpected turn this week when surgeons in South Africa announced that they had successfully transplanted the penis of a dead person onto a young man.

The story started when a 21-year old man, whose penis had been “amputated” three years previously, sought medical help. He reported that, during an “initiation ceremony” a few years earlier, an inept surgeon who intended to perform a circumcision cut off not just foreskin but the entire penis.

The unnamed patient is not alone. According to The Guardian, in one province where the ceremony is commonly performed among teenagers, usually in secret, this complication—a penis accidentally severed or else removed to treat severe local infection and gangrene—occurs in 250 men a year. Now there’s a vote for tighter regulation.

The South African surgical team reported that during the nine-hour operation they were able to connect the donor penis to the patient despite the three-year interval since amputation. Details of the donor are few but surely his death had to have been quite recent, given the need to transplant any tissue from dead to living as quickly as possible to assure preservation of vital anatomy and function.

Details of the recipient’s sex life though are pretty loudly trumpeted. He is a full go, per the surgeons, who noted that he developed an erection during a recent minor operative procedure that involved removing a urinary catheter. In all ways, he “accepts the organ as his own.”

Leaving aside the societal and ethical issue of ceremonial initiations involving genitalia in young adults and the inevitable debate on how-is-this-different-really-than-American-newborn-foreskin-pruning; leaving aside even the needed material this will provide Jimmy Fallon, Conan O’Brien, et al during their parched spell as they try to find something funny to say about Hillary Clinton and email, this switcheroo may be the start of something quite bad.

We already have a disturbing problem with a black market in human parts that extends well outside of New Jersey. There is international trade with kidneys and the like being harvested from China’s prisoners to implant into transplant tourists and wealthy locals.

So if indeed the South Africans have taken a step forward in organ transplant—and the first heart transplant was performed there almost 50 years ago, so they do have a track record of surgical audacity—it is difficult to imagine the world not working the progress forward first in humanitarian, then in much more selfish directions. The number of people needing a penis transplant for medical reasons, beyond the few hundred in South Africa a year and a handful who have suffered trauma, is unlikely to drive a market.

But vanity surely can. The world long ago embraced cosmetic surgery as something you can get, guilt-free, if you can afford it. It’s a multi-billion dollar industry led by Brazil, Venezuela, Mexico, South Korea, and of course the US. Breasts, lips, eyelids, and much more each are remolded by a surgeon’s touch by the hundreds every day.

Data on surgical enhancement of the penis for cosmetic reasons though has a different geographic distribution (pdf). For this procedure, the Germans lead the world undergoing 10 times more procedures than any other country.

The current status of surgical penis enhancement lies somewhere between the primitive and the barbaric, so the notion of a complete replacement part rather than a reconstruction or rearrangement is not far-fetched. Of course the pain of the procedure as well the fact that it is a literal castration seems like a pretty scary thought, one that might dissuade many from moving forward.

But if indeed the penis transplant technique is improved, we soon may have to consider an entire eco-socio-psycho-Dr. Phil-anthropomorpho-societal implications of the intervention, such as who gets what, when, and where. And how to handle the black market. And whether Medicare should pay (they pony up $20 million a year for penis pumps already).

Yes, the news from South Africa might signal the introduction of Big Penis, a new kid in town to stand shoulder to shoulder with Big Pharma and Big Oil. But this will be an industry exclusively for and about men, monitored by men, contributed to exclusively by men, administered by men for the greater good of men. Now that is really a scary thought.