What You Should Know About A Penile Fracture

This article takes a detailed look into the causes, symptoms, and treatment options of penile fracture. 

Although a penile fracture is not a typical situation, it is alarming because it can cause complications such as erectile dysfunction and the formation of fistulas if untreated.

What is a Penile Fracture?

Tunica albuginea is a tissue with a rubbery sheath structure that is located right beneath the skin. An increased blood flow in this rubbery sheath of tunica albuginea causes an increase in the length and width of the penis during erection

A tear in this rubbery sheath of tunica albuginea is called penile fracture. Corpus cavernosum is another sheath of tissue located beneath the tunica albuginea. Sometimes, during a penis fracture, there can also be a rupture of the corpus cavernosum.

The penile fracture should be considered a medical emergency. A delay in the treatment can lead to permanent sexual dysfunction.

Symptoms

Some symptoms of penile fracture are like any other common injury. And some signs of fracture are typically associated with this injury. 

1. Profuse Bleeding

The blood supply of the penis is rich as compared to most of the organs of the body. The blood flow to the penis increases explicitly during sexual intercourse to cause an erection. 

If the fracture occurs in an erect penis, it may cause rupture of the blood vessels. Since blood flow to the penis is very profuse during an erection, the blood loss may be excessive.

2. Bruising on Penis

Bruising is a reaction of the body to tissue injury in any part of the body. Even if there is no blood vessel rupture during a penile fracture, the vascular permeability increases. 

The damaged tissue of the penis gives rise to inflammatory signals that cause dilation and increased permeability of the blood vessels. There is leakage of protein and inflammatory cells to the site of injury. This leads to the inflammation and bruising of the penis.

3. Painful Urination

During the penile fracture, there can be some pressure injury to the urethra. This pressure injury causes painful urination

4. Cracking Sound

During a penile fracture, a crackling sound is often produced. If a sudden loss of erection follows the crackling sound, it is probably a fractured penis.

5. Pain

The penile fracture is associated with pain, but the intensity of the pain varies from patient to patient. So there can be mild to severe pain.

6. Eggplant Deformity

Eggplant deformity is a specific term that doctors often use for a fractured penis. In eggplant deformity, the penis becomes purple and swollen.

7. Swelling of Scrotum

The swelling of the scrotum is among the rarest symptoms of penile fracture. The swelling of the scrotum can be due to direct injury to the scrotum. It can also be due to the extension of inflammation to the scrotum.

According to researchers, the crackling sound production and sudden loss of erection are necessary indications of a fractured penis. If there are all other symptoms of a fractured penis but there is no loss of erection, it is due to some other cause. 

The symptoms of penile fracture may become complex if there is a rupture of some artery or vein and the tunica albuginea damage. There can also be rupture of the suspensory ligament in some cases.

Causes

1. Sexual Intercourse

A wild or too passionate sexual intercourse is one of the common causes of penile fracture. When a man thrusts his penis in the vagina, he may cause a rupture due to the sudden application of force on the penis.

During such sexual intercourse, the man might also hit the penis against public bone or perineum instead of the vagina, leading to a penile fracture.

2. Traumatic Masturbation

Traumatic masturbation is another cause of penile fracture. Frequent and too forceful masturbation causes weakening of tunica albuginea and corpus cavernosum, which can ultimately result in penile fracture. During masturbation, the person might increase the hand’s grip for more pleasure, resulting in penile fracture.

3. Fall on Erect Penis

If a person falls during the penile erection, there can be a penile fracture. Though a penile fracture due to a fall is very rare, it is often severe. During a sudden fall with an erect penis, the whole body’s weight suddenly goes on the penis, which causes excessive damage. 

In such cases, there is often damage of corpus cavernosum along with tunica albuginea. There can also be rupture of some artery or vein. 

4. Rolling Over in Bed during Sleep

Men can experience a penile erection while asleep because of dreams or just due to the inactivation of the sympathetic system. If a man rolls over the bed during sleep with a penile erection, there can be a penile fracture. The extent of penile fracture from rolling over the bed depends on how much weight is put on the penis.

5. Taqaandan

Taqaandan is a method of bending the erect penis to get rid of penile erection at the wrong place and time. This method is practiced by some men in the middle east and central Asian countries. This method can sometimes cause a penile fracture.

6. Certain sexual positions

Though a penile fracture can occur during sexual intercourse irrespective of position, a woman on top during intercourse increases the risk of penile fracture. During the initial penetration, the penis is momentarily blocked at the vaginal opening. 

During that momentary blockage, the whole weight of the woman rests on the penis, which can cause a penile fracture. The woman may also bend forward or backward beyond the movement of the penis, causing a penile fracture.

When to See a Doctor

The issue of a penile fracture is very sensitive. Hence, if a man has even the slightest notion that he has fractured his penis, he should immediately consult a doctor. 

The doctors also consider penile fracture a medical emergency because it can lead to permanent dysfunction of the reproductive and urinary systems.

It is better to report to the hospital’s emergency department as soon as possible. The earlier a man comes to the hospital, the greater the chance is of recovery.

Diagnosis

The diagnosis of penile fracture is based on history, physical examination, and lab results.

1. History

History taking is one of the most critical components in making the diagnosis of any disease. If a patient presents with symptoms of penile fracture, the doctor will ask him some related questions. 

Here are some common questions a doctor might ask:

  • Did you hear any sound that made you suspicious about a penile fracture?

  • Do you have pain?

  • How severe is the pain in the penis?

  • Do you feel any difficulty in urination?

  • Do you have blood in your urine?

  • Was there any bleeding at the time of the fracture? 

  • Did you have sexual intercourse at the time when you fractured your penis?

2. Physical Examination

The second step of the diagnosis of penile fracture is a physical examination of the perineum. In the physical examination, the doctor will look at the size and shape of the penis. 

They will also look for any bruises or signs of inflammation. The doctor may also examine the scrotum and nearby lymph nodes to role out any other disease.

3. Imaging Techniques

The imaging techniques are used to confirm the diagnosis of penile fracture. The first imaging technique is the X-ray of the penis or cavernosograohy. A special dye is injected into the blood vessels of the penis before the X-ray. 

The other imagings used include ultrasound and MRI. These imaging techniques give the details of different tissue layers of the penis.

If the patient experiences difficulty or pain during urination, there may be a need for some additional tests to rule out the involvement of the urethra.

Treatment of a Penile Fracture

The treatment of a penis fracture is often surgical repair. However, some home treatments can be used to prevent further damage before you reach the hospital.

Surgical Treatment

In the surgical treatment of a penile fracture, the surgeon will make an incision on the skin of the penis to expose the underlying tissue layers of tunica albuginea and corpus cavernosum. The size and of the incision vary according to the extent of the injury. 

The aims of the surgical treatment:

  • Removing any blood clot or hematoma that is made as a result of injury

  • Ligation of the ruptured arteries or veins to stop the bleeding

  • Cleaning and closing any cut or laceration of the penile tissue

  • Surgical repair of the urethra, if there is the involvement of the urethra

After cleaning the hematoma and ligating any damaged structure, the penile tissue is approximated and fixed with stitches.

Home Treatments

Home treatments of a penis fracture are not a permanent solution. These treatments are given just to prevent further tissue damage before reaching the hospital. 

The home treatments include:

  • Applying ice packs on the fracture site to avoid bruising

  • Emptying the bladder with a Foley catheter to lower the bladder pressure on the penis

  • Taking anti-inflammatory drugs such as ibuprofen to reduce pain and control inflammation

It is stressed not to entirely rely on home treatments to prevent long-term losses. These home treatments are just a way of keeping things under control before reaching the hospital.

Recovery

After surgical treatment, the period of hospital stay varies according to the extent of the injury. According to the doctor’s recommendations, it may be necessary to take painkillers and other medications for a faster recovery. 

Complete recovery after a penis fracture usually takes months. During this period, the patient should visit the doctor regularly to check for healing progress.

It is necessary to avoid sexual intercourse during the period of penile fracture recovery. Sometimes the doctor may suggest some medications to keep the sexual desires of the patient under control during the period of recovery.

The success of surgical treatment is satisfactory. Most of the patients fully recover their sexual and urinary health after surgical treatment. Some researches show that in 90 percent of the patients, the surgical treatment works without causing any complications.

Complications

An untreated penis fracture leads to long-term complications. Additionally, there can be some complications after the surgical treatment. The complications of penile fracture include:

  • Curved penis due to weakening of tunica albuginea and corpus cavernosum

  • Fistula formation

  • Pain during erection and sexual intercourse

Penile Fracture and Sexual Intercourse

A penile fracture causes a temporary inability to have sexual intercourse. However, if the tissue of the penis does not heal properly, it can also cause long-term sexual inability.

Right after the fracture, the erection is lost, and the ability of sexual intercourse is lost. The penis cannot be erected as long as the tissue does not heal. A man also needs to avoid sexual intercourse during the recovery of a penis fracture. 

If a man tries to have sex during the recovery period of a penis fracture, he may damage the healing tissue resulting in permanent sexual dysfunction.

Additionally, an untreated penile fracture can cause erectile dysfunction. In some cases, tunica albuginea and corpus cavernosum do not heal properly even after the surgical treatment. The ultimate result can be the inability to perform sexual intercourse.

Conclusion

Penile fracture is a medical emergency in which the tunica albuginea of the penis is damaged. In some cases, there can also be damage to the corpus cavernosum and urethra. 

The symptoms of penile fracture include crackling sound, loss of erection, painful urination, and bruising of the penis. The fracture is usually caused during sexual intercourse. However, it can also be caused by traumatic masturbation, a fall on the erect penis, and taqaandan.

If someone has even the slightest doubt of a penis fracture, he should immediately consult the doctor to avoid complications. The doctor will diagnose based on history, clinical examination, and X-ray results. 

The only reliable treatment of penile fracture is surgical repair. If the patient takes proper care after the surgical repair, there are significant chances of recovery from a penis fracture. An untreated or improperly managed penile fracture can cause complications such as erectile dysfunction and the formation of fistulas.

Next Up

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Penile Pain: 9 Probable Causes and Practical Treatment Options.

Sources

  1. Diaz KC, Cronovich H. Penis Fracture. [Updated 2021 May 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551618/
  2. Mirzazadeh, M., Fallahkarkan, M., & Hosseini, J. (2017). Penile fracture epidemiology, diagnosis and management in Iran: a narrative review. Translational andrology and urology, 6(2), 158–166. https://tau.amegroups.com/article/view/13975/14793
  3. Jack, G. S., Garraway, I., Reznichek, R., & Rajfer, J. (2004). Current treatment options for penile fractures. Reviews in urology, 6(3), 114–120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472832/
Alternative Text

Dr. Akeel Salahudeen

Dr. Akeel Salahudeen obtained his medical degree from the Nishtar Medical University, Pakistan. He is now an internal medicine intern at the Nishtar Hospital, Pakistan.

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