Penile fractures – now those are two words that cause many people to wince and cover their eyes while shouting “No, No, No!”. Unfortunately, this is an injury that is frequently heralded by an audible crack followed by severe pain for the recipient – and it happens a bit more often than people may think.
First up, an anatomy lesson
Before we explore this cringe-worthy injury we need to explain the structure of a human penis (other animals can have a bit more wacky anatomy… looking at you ducks).
Anatomically, the penile structure is divided into two areas: the external portion and the root. The root begins directly below a gland called Cowper’s or the bulbourethral (which sounds like Pokémon), with a long cylindrical body of spongy tissue known as the corpus cavernosum. Surrounding this is a fibrous envelope called the tunica albuginea.
A beautiful diagram of the inside of a penis.
Image credit: Surasmuk/Shutterstock.com
What is a penile fracture?
Penile fractures are defined as the rupture of the tunica albuginea and they are classed as a urological emergency, as around 25 percent of cases are accompanied by urethral injury. If you’re unfortunate enough to experience this, then the standard management protocol involves getting a prompt diagnosis, which will likely lead to surgical intervention.
Instead of one, how about two penile fractures?
There are many leg-crossing stories that land on our desks at IFLScience, and one is a case outlining a double penile fracture. We have taken a look at the paper so that you don’t have to (trust us, it’s grisly, to say the least).
The paper was published this year and involved a 27-year-old patient who came into hospital with pain in his penis that seemed to have occurred during sleep. Although this may sound like an excuse or a nightmare, it may not be unique.
For the patient, after a snapping sound, they ended up having immediate swelling of the penis and they delayed seeking medical attention, waiting 36 hours after getting the injury. The doctors at the hospital immediately saw significant swelling and there was an “eggplant deformity”. The visually strong name of eggplant or aubergine deformity is another name for penile fracture.
The medical professionals conducted a penile ultrasound which luckily revealed no evidence of a urethral injury. These types of injuries can allow urine to leak into the tissues around them and can cause infection and pain in the belly. For the patient, ultrasounds did reveal extensive subcutaneous edema that extended to the scrotum, which pretty much means swelling that happens in a specific layer of the skin. There was also a large hematoma (pool of mostly clotted blood) near the base of the penis – which is no surprise given the type of injury.
In this case, there was a surgical exploration of the injury under spinal anesthesia (yes this does mean that the patient was awake for this process). The paper itself is graphic: the penis was “degloved” during surgical investigations, which means that the skin is cut back so that the surgeons can investigate the urethra for any additional damage – like removing a banana peel to take a look at the inside then once done carefully putting it back together and stitching it up.
The surgery found two distinct fractures at the base of the corpora cavernosum, which measured 10 and 7 millimeters (0.4 and 0.3 inches), respectively. They were repaired using sutures. Luckily for the patient, it was an uneventful recovery period, where they regained full erectile function by the fourth day and 12 months later there were no complications reported. Still, those must have been a tough few days!
He is also not alone – in 2015, there was another reported double penile fracture. This had a similar scenario as the first, where a 23-year-old patient turned on his erect penis while “asleep” at night, and waited 36 hours before limping to the hospital.
What is the treatment for penile fractures?
Cases of penile fractures have been found throughout human history. Over a thousand years ago, the first documented penile fracture was recorded by the Arab physician Abu al-Qasim in Cordoba.
In the past, recommendations for penile fractures included more conservative approaches like a cold compress, and, in the 20th century, antibiotics, anti-inflammatory medicines, and anti-androgens. However, patients often had a high incidence of complications (over 50 percent), such as a palpable nodule, penile curvature, and infected hematoma, and often had a prolonged hospital stay and recovery.
Nowadays, it is recommended that patients receive immediate surgical repair for penile fractures. This can produce better outcomes and decrease hospital stays.
What causes penile fractures?
These injuries tend to happen when someone is aroused, as this causes blood to flow into the erectile tissue, making the penis rigid and hard. Forcing the penis to bend, falling on it, rolling clumsily during sleep, or even having an object (or person) land awkwardly on it during an erection can cause fractures.
In one study, they found that “women on top” positions during heterosexual sex caused the highest amount of penis fractures in a small sample group.
In another study, researchers discovered that penile fractures happened to 1.02 per 100,000 male subjects a year in the United States between 2010-2014, with more occurring during weekends and summer months. This relates to a sexual activity increase demonstrated in previous research (17.4 attempts a week in the winter to 28.1 in the summer and more multiple copulations occurring on the weekend compared to weekdays).
Some research suggests more penile fractures tend to happen over holidays like Christmas compared to non-holidays, possibly because couples are enjoying more moments of relaxation. Incidentally, the COVID-19 pandemic and the lockdown period did not affect the incidence of penile fractures in the same study.
Penile fractures aren’t the only injury that can occur to the male member. The “banjo string“, or penis frenulum, can also tear and can cause pain and bleeding in the area and this type of injury can occur during enthusiastic bedtime shenanigans.
Moral of the story is please try and be careful when doing bedroom “exercises” or even when moving into different sleeping positions, but if anything does happen, be sure to go to the emergency room as soon as possible to be treated.
The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
