Penile Injuries

Several types of injuries can affect the penis. Catching the penis in a pants zipper is common, but the resulting cut usually heals quickly. Cuts and irritations heal quickly without treatment but may need antibiotics if they become infected. Injuries to the urethra (the opening at the end of the penis) may require other specific treatment, usually provided by a urologist (a doctor who specializes in the diagnosis and treatment of genitourinary  disorders).

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Fracture of the Penis

can occur from excessive bending of an erect penis. Pain and swelling from damage to the structures that control the erection and difficulty with intercourse or urination follow. Fractures of the penis usually occur during vigorous sexual intercourse. Emergency surgery is usually necessary to repair such a fracture to prevent abnormal curvature of the penis or permanent erectile dysfunction (impotence). The penis can also be partially or fully severed. Reattachment of a severed penis is sometimes possible, but full sensation and function are rarely recovered.

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The location of the scrotum makes it susceptible to injury. Blunt forces (for example, a kick or crushing blow) cause most injuries. However, occasionally gunshot or stab wounds penetrate the scrotum or testes. Rarely, the scrotum is torn off the testes. Testicular injury causes sudden, severe pain, usually with nausea and vomiting. Ultrasound may show whether the testes have ruptured. Ice packs, a jockstrap, and drugs for pain and nausea usually effectively treat internal bleeding in or around the testes. Ruptured testes require surgical repair. When the scrotum is torn off, the testes can die or lose their capacity for hormone or sperm production. Surgery to bury them under the skin of the thigh or abdomen may save the testes.

What is a penis fracture?

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Although the penis has no bone, there are ligaments in the penis.  When these ligaments are torn, a penile fracture occurs. 

What is penile injury? 

Injury or trauma to the penis can be accidental or deliberate.

Deliberate penile injury is a particularly violent event that is usually self-induced, or inflicted by a jealous partner or their former lover.

Despite the publicity surrounding a case of penile amputation in the USA, deliberate penile injury is rare in Western cultures, but seen more often in the Far East. Common injuries are:

• penile amputation

• penile fracture.

Fracture of the penis 

Fracture occurs when an abnormal force is applied to the erect penis. The 'fracture' is actually a tear in the tunica albuginea, the thick fibrous coat surrounding the corpora cavernosum tissue that produces an erection. It is an uncommon injury, usually but not always the result of damage to the penis during sexual intercourse. Most cases (75 per cent) occur on one side, 25 per cent affect both sides and in 10 per cent the tear extends into the urethra.

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What are the symptoms of penile fracture?

• A 'cracking' noise.

• Pain.

• Bruising.

• Immediate loss of erection.

• Bleeding from the urethra may occur if the urethra is damaged.

What causes a penis fracture?

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In most cases, a penile fracture occurs during intercourse.  The penis is most vulnerable when fully erect.  This is when it is stretched to the limit, so to speak.  If the penis hits something hard, like the body of your wife or girlfriend landing on top of you after you have slipped out of her, this can result in a broken penis.

What do I do about a penis fracture?

You go to the hospital, plain and simple.  This is a medical emergency and failure to treat a penile fracture can result in a number of complications, among them is permanent erectile dysfunction.  In order to avoid any complications, go to the emergency room.

When does this occur & how? 

Obviously, sexual activity can play a role.  Upon penetration, if the vaginal introitus is missed and the penis suddenly hits the thigh or introitus, a rapid rise in pressure can cause disruption of this capsule and fracture of the penis.  Frequently, a loud noise is made at the time of the fracture, as if a bone was cracking.

On occasion, sudden bending of an erect penis in young males awakening in the morning can also lead to a fracture as can an array of trauma accidents. Still, all told, it is a relatively rare occurrence.

Surgery is obviously indicated and usually involves circumscribing the penis, reflecting the skin of the shaft of the penis, evacuating the clots and debris and suturing closed the traumatic injury to the capsule of the corpora cavernosum.  

Erectile dysfunction is certainly a major complication of this injury and should be discussed with your patient prior to surgery. After full healing in 6-8 weeks, use of PDE5 drugs (Viagra, Cialis and Levitra) to help prevent against this problem should be used.

How do I avoid a penile fracture?

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The only way to avoid a penile fracture  is to be extremely careful during intercourse.  As most cases of a penile fracture, the incident occurs when the woman is on top of the man.  You can avoid this position if you want to avoid a penile fracture.  Or you can just be a little careful when you have sexual intercourse in this fashion, although this is a pleasurable position for most women. 

If, however, you find that you can only enjoy sexual intercourse with your wife or girlfriend on top because you are too tired to maintain sexual stamina in other positions, perhaps it is time for male enhancement pills.

Injured Penis: The Fracture

It's perhaps the greatest irony of a man's sexual 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 the erect penis. The 'fracture' is actually a tear in the tunica albuginea, the thick fibrous coat surrounding the corpora cavernosum tissue that produces an erection. It is not a common injury to the penis during sexual intercourse, but it can happen. Penile fracture can only occur with an erection.

Most cases (75 per cent) occur only on one side, but sometimes the injury affects both sides. Also, a small portion of the injured penis population tear extends into the urethra.

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Penile fractures can also happen during masturbation. Although, most injuries that result from masturbation come from forcibly hiding an erection without care and fracturing it.

There is one common scenario/position that results in many penis fractures. In this scenario, the female partner is on top during intercourse, as the penis thrusts in and out it becomes dislodged from the vagina and when attempting to reinsert it, the partner comes down hard on the penis, striking the female pelvic bone, and creating a sudden bending of the penis. A sure sign is a loud snap and excruciating pain following the injury, as well as the rapid development of a 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 be in excruciating pain and notice black-and-blue marks 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 the procedure where urologists or radiologists place a fine needle into the corporal body of the penis and inject 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 delayed repair of urethral injuries.

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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. Also, another problem with conservative management is that fibrosis of the lining of the corporal body can create a bend and poor healing, similar to the effects of 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 the 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. The men 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

Treatment

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