Intracavernosal self-injection (ICI) is an effective treatment for erectile dysfunction. A rare but serious complication is needle breakage. We report an unusual case of a 51-year-old transgender female patient who did not desire gender-affirming surgery, and used ICI to treat her longstanding erectile dysfunction. She presented to the emergency department 2 months after needle breakage during ICI, and was subsequently successfully treated with intraoperative fluoroscopy and needle fragment extraction. It is important to recognize transgender patients may desire to preserve sexual function, and for providers to engage in discussion surrounding sexual health throughout treatment for gender dysphoria.