Penile Fracture - "Ouch!"
This is a rare condition which I was not going to dedicate a whole page to... until last week when a man came into the emergency room with a penile fracture 4 days prior to presenting to the hospital. Therefore I decided to create a page for it to help educate and spread the word about the importance of recognizing it when it happens so that you or your friend rush to the ER because prompt treatment (<24h) has been shown to improve long-term outcomes in studies.
What is it?
A penile fracture is a rare and alarming injury that may occur during sexual intercourse. A penile fracture is not the same as a break in a bone. Instead, it is a rupture in the two areas of the penis responsible for erections: the corpora cavernosa and the penile sheath.
Because the injury can cause long-lasting damage to a man's sexual and urinary function, it is important to seek emergency medical attention.
A penile fracture may occur during sex. A penile fracture is a painful injury that usually occurs in the lower two-thirds of the penis. Symptoms of a penile fracture include:
- bleeding from the penis
- experiencing dark-colored bruising to the penis
- having trouble urinating
- hearing a cracking or popping sound
- losing an erection suddenly
- pain that varies from minimal to severe
A penile fracture will often cause the penis to take on what doctors call an "eggplant deformity," where the penis appears purple and swollen. Rarer symptoms of a penile fracture include swelling in the scrotum and blood in the urine. Other conditions that mimic the symptoms of a penile fracture include a rupture of the veins and arteries in the penis and a ruptured suspensory ligament.
The penis has an area of sponge-like tissue called the corpus cavernosa. When a man has an erection, the blood in the penis concentrates in this area. When the penis is erect, one or both sides of the corpus cavernosa can snap, resulting in a penile fracture.
A penile fracture will usually only occur when a man's penis is erect. A flaccid penis does not typically fracture because the corpus cavernosa is not as enlarged as when the penis is erect. Most cases of penile fracture in the United States occur during intercourse. The injury usually happens when a man is thrusting against the pubic bone or the perineum, which can cause the corpus cavernosum to snap or break.
Men are not necessarily having rough sex when a fracture occurs, but may be in a position where the penis is more likely to hit against a bone.
However, a penile fracture has also been known to occur in the following circumstances:
- rolling over in bed onto an erect penis
- hitting an erect penis on something, such as a door frame or furniture
- falling onto an erect penis
Treatments for a penile fracture can include at-home care and surgical repair.
At-home treatments include:
- Applying cloth-covered ice packs for 10 minutes at a time to reduce swelling.
- Using a Foley catheter to empty the bladder and reduce trauma to the penis.
- Taking anti-inflammatory medications, such as ibuprofen, to reduce pain and swelling.
Using at-home treatments alone has been shown to cause high rates of complications following a penile fracture. Examples of these include pain when getting an erection, a severe angle to the penis, and inability to achieve an erection.
As a result, many doctors recommend surgical repair and treatment. Research has shown that surgery results in better outcomes for people with penile fractures especially when performed less than 24 hours after the event..
Surgical treatment can vary based on the extent of a man's injuries. Examples of repairs that may be made after a penile fracture include:
- getting rid of a hematoma or buildup of blood due to the fracture
- stopping bleeding of any damaged blood vessels
- closing any cuts or lacerations to the penis that may be causing bleeding.
If a man's urethra is also damaged, we may need to repair it as well. We routinely perform urethroscopy with a tiny camera to inspect the inside of the urethra at the time of surgical repair.
To repair the penile fracture, we would make an incision in the skin of the penis to access the one or more torn areas. We then repair these tears with stitches.
If a man does not seek treatment for a penile fracture, it is possible that he could experience a permanent penile deformity.
An untreated penile fracture may also lead to difficulty maintaining an erection (Erectile Dysfunction).
Bottom line: if you think you have a penile fracture or if you hear a popping noise during sex and then your penis swells up and you loose your erection, better to come to the ER to get checked out.