It's perhaps the greatest irony of a man's sex life: The harder the penis is, the more vulnerable it is to injury.
Fractures to the penis, although uncommon, do occur when an abnormal force is applied to it in its erect state. The 'fracture' is actually a tear in the tunica albuginea, the thick fibrous coat surrounding the corpora cavernosum tissue that produces an erection. Such a penile fracture can only occur when the penis is erect. Though it is an unlikely injury to occur during sexual intercourse, it has happened many times.
Most cases (75%) occur to only one side of the penis, but sometimes the injury affects both sides. Also, a small portion of the injured penis’ wound or tear usually extends into the urethra, further complicating matters.
Penile fractures can also happen, indirectly, during masturbation. If the masturbator is surprised by the sudden presence of someone, a quick attempt to forcibly hide an erection without care can result in a fracture.
There is one common scenario that results in many penis fractures. It’s when the female partner is in the ‘on top’ position during intercourse. As the penis thrusts in and out it becomes dislodged from the vagina. While attempting to reinsert, the female inadvertently comes down hard on the penis, striking it with her pelvic bone, suddenly crushing it. A sure sign of the injury is a loud snap and subsequent excruciating pain, as well as the rapid development of hematoma or bruise. These injuries are not difficult to diagnose, and symptoms will depend upon the severity of the fracture.
Men with penile fractures will find them difficult to endure. Black-and-blue marks will appear in close proximity to the injured area on the penis. When the diagnosis is equivocal (a large bruise, but no obvious distortion or destruction) the penis is evaluated with corporal cavernosography. This is a urological procedure where a radiologist places a fine needle into the corporal body of the penis and injects contrast material in order to examine the shape of the corporal bodies and to test for leakage. If there is a question of urethral injury, a retrograde urethrogram is also performed in which contrast material is instilled down the urethra via a small tube or catheter to test for leakage. Urethral injury is usually evident with blood in the urine.
Historically, conservative therapy was considered the treatment of choice for penile fractures. Conservative therapy consisted of cold compresses, pressure dressings, penile splinting, anti-inflammatory medications, fibrinolytics, and suprapubic urinary diversion with delay repair of urethral injuries.
However, this concept has fallen into disfavor due to the high complication rates (29-53%) of non-operative therapy. Complication rates of conservative management included missed urethral injury, penile abscess, nodule formation at the site of rupture, permanent penile curvature, painful erection, painful coitus, erectile dysfunction, corporourethral fistula, arteriovenous fistula, and fibrotic plaque formation. Another related problem is that of fibrosis of the lining of the corporal body creating an unnatural curve due to poor healing, similar to the effects of a maltreated broken arm. Additionally, complications from expanding blood clots, such as a blood clot accumulation or a hematoma (or an infection of the hematoma) can occur as well.
Because of the risk of major complications stemming from penis fractures, surgery is the best treatment for a serious injury. These days, primary goals of surgical repair are to expedite the relief of painful symptoms, prevent erectile dysfunction, allow normal voiding, and minimize potential complications from delay in diagnosis. The faster the torn tissues can be re-approximated, the sooner the healing process can begin. Those with penile fractures caused from sexual intercourse are typically young, sexually active, and highly motivated to resume sexual activity as soon as the healing process is complete. This means that surgery is often the best choice and the best treatment.
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