Penile fracture is a relatively rare but serious urological emergency that occurs when the tunica albuginea, the fibrous covering of the corpora cavernosa, ruptures. This injury typically happens during sexual activity when excessive force or abnormal bending causes a rupture in the penis while it is erect. Although the term "fracture" might suggest a break in a bone, the penis doesn’t contain bones. Instead, it is the tearing of the tissue within the penile shaft that causes the injury.
Penile fractures require immediate medical attention, as delayed treatment can lead to complications such as erectile dysfunction or penile deformity. Here we’ll explore the causes, risk factors, symptoms, and treatments for penile fractures.
What Causes a Penile Fracture?
Penile fractures most commonly occur during vigorous sexual intercourse. The injury is usually the result of the penis slipping out of the partner and forcefully hitting the pubic bone or perineum. Other causes include:
Masturbation: In rare cases, aggressive or unusual methods of self-stimulation can result in penile injury.
Trauma during sleep: Though uncommon, some men have reported penile fractures occurring during nocturnal erections or sudden movement while asleep.
Injury from accidents: Accidental trauma to the groin area while engaging in physical activities or sports can also lead to this condition.
Manipulation or bending: Some individuals attempt to manually bend the penis, which can increase the likelihood of a fracture.
Risky Positions During Intercourse
Several sexual positions are associated with a higher risk of penile fracture. Here are some positions to be mindful of:
Cowgirl (woman-on-top): This is considered one of the riskiest positions for penile fractures. When the partner on top loses control or comes down too forcefully, the penis can be bent at an awkward angle, leading to a rupture.
Reverse Cowgirl: In this variation of the cowgirl position, the partner faces away from the male partner. The lack of visual connection may make it more difficult for the man to guide or adjust if something feels wrong.
Doggy Style: This position places the penis in a more vulnerable position because of the angle of penetration. Sudden shifts in movement or loss of alignment can increase the risk of trauma.
Standing or Kneeling Intercourse: Any standing or kneeling position that involves thrusting without support can increase the risk of losing balance, which may lead to penile injury.
Missionary with aggressive thrusting: While generally considered a safer position, aggressive thrusting can still cause accidental injury, especially if the penis slips out and is met with resistance when attempting to re-enter.
Symptoms of Penile Fracture
A penile fracture is usually unmistakable because of the dramatic and painful symptoms that accompany it. If a man experiences any of the following, he should seek emergency medical care immediately:
Audible "popping" sound: The most common indicator of a penile fracture is a distinct popping or cracking sound, which signifies the rupture of the tunica albuginea.
Immediate pain and swelling: Severe pain follows the popping sound, accompanied by rapid swelling, which often gives the penis a “purple eggplant” appearance, also known as the "aubergine sign".
Loss of erection: The penis will typically lose its erection immediately following the injury, and bruising will spread quickly.
Bent or deformed penis: As blood leaks from the corpora cavernosa into surrounding tissues, the penis may appear bent or misshapen.
Hematoma: Blood may pool under the skin, creating large, visible bruises.
Diagnosis and Treatment
Diagnosis
Upon arriving at a medical facility, the physician will perform a physical exam and may request diagnostic imaging to confirm the presence and extent of the fracture. Magnetic resonance imaging (MRI) or ultrasound may be used to visualize the injury. A retrograde urethrogram could be recommended if there’s concern about potential damage to the urethra.
Treatment
Immediate surgery is the gold standard for treating penile fractures. Non-surgical approaches may lead to complications such as erectile dysfunction or penile curvature. During surgery, the urologist will repair the ruptured tunica albuginea and drain any collected blood to prevent scar formation. Early intervention leads to the best outcomes, with most patients regaining full erectile function and experiencing minimal long-term effects.
Conservative treatment is rarely recommended and typically involves bed rest, pain management, and anti-inflammatory medication. However, this approach is associated with higher risks of complications, including erectile dysfunction and painful erections.
Long-term Complications of Untreated Penile Fractures
Failure to treat a penile fracture promptly can lead to several long-term complications, including:
Erectile Dysfunction: Damage to the blood vessels and tissue in the penis can impair its ability to become erect.
Penile Curvature: The formation of scar tissue can cause the penis to bend during erections, a condition known as Peyronie's disease.
Pain during intercourse: Inadequate healing can lead to chronic pain during sexual activity.
Urethral Damage: In some cases, the urethra may be injured, leading to issues with urination and pain.
Preventing Penile Fractures: Best Practices
While it’s impossible to eliminate all risks associated with sexual activity, there are several strategies that can help reduce the likelihood of penile injury:
Communication with your partner: Clear communication during sexual activity ensures that both partners are aware of what feels comfortable or potentially harmful.
Avoid high-risk positions: If you are concerned about penile fracture, avoid positions that put the penis in vulnerable positions, such as cowgirl or reverse cowgirl.
Take your time: Slow, deliberate movements can help prevent accidents. Avoiding aggressive or forceful thrusting is key to reducing risk.
Stay in control: If you are the penetrative partner, try to maintain control of the angle and depth of penetration. If your partner is on top, guide their movements when needed.
Listen to your body: If something feels wrong or painful during intercourse, stop immediately and reassess.
Recovery After Penile Fracture
Post-surgery recovery from a penile fracture typically involves:
Rest: Patients should avoid physical activity, including sexual intercourse, for about 6 weeks or as directed by their physician.
Pain management: Pain relief medications may be prescribed to manage post-operative discomfort.
Follow-up care: Regular follow-up appointments with a urologist are essential to ensure proper healing and assess erectile function.
Pelvic floor exercises: In some cases, pelvic floor therapy can help strengthen the muscles and improve blood flow to the genital area, aiding in recovery.
The Role of ESWT in Recovery from Penile Fracture
While ESWT is not a treatment for the fracture itself, it can be helpful in the rehabilitation phase. Research suggests that shockwave therapy may aid in recovery from erectile dysfunction and Peyronie’s disease, both of which are potential complications of penile fractures. By enhancing blood flow and promoting tissue healing, ESWT may be a valuable adjunct therapy in helping patients regain normal erectile function.
Conclusion
Penile fractures are a painful and traumatic injury that require immediate medical attention. While high-risk sexual positions can increase the likelihood of this injury, good communication, mindful movements, and maintaining control during sexual activity can reduce the risks.
Surgical repair is the gold standard treatment for penile fractures, and while ESWT may be helpful in managing complications such as erectile dysfunction and Peyronie’s disease, it is not an alternative to surgery. Always consult with a urologist if you suspect a penile fracture to ensure the best possible outcome.
