Penile fracture: symptoms, causes and treatment
A penile fracture is an injury that is often misunderstood. After all, how can you fracture – or break – your penis when, technically, there is no bone to fracture?
Nonetheless, penile fracture is more common than one would think, particularly as a result of overenthusiastic sexual activity.
Dr Roger Henderson looks at the causes of penile fracture and treatments available.`
What is a penile fracture?
Men and people with penises do not have a bone in the penis. Rather, erection hardness is maintained by blood flooding two balloon-like tubes, called the corpora cavernosa in the penis. This stretches their outer wrapping – called the tunica albuginea – making it taut and, as a result, the penis becomes erect and hard.
A penile fracture is not the same as breaking a bone. Instead, it is a tear in the tunica albuginea (and sometimes the corpora cavernosa as well) that typically occurs when there is sudden trauma or bending of the penis when erect.
Penile fracture causes
The most common cause is trauma during intercourse. Rough sex does not necessarily make the risk of penile fracture greater. However, some sexual positions can increase the risk or penile fracture, with the cowgirl position – or the woman on top – being the most commonly reported cause of penile fracture, due to the penis being rocked backward or forwards too far with the full weight of the woman on it.
Research published in Advances in Urology (which looked at patients who attended A&E with suspected penile fractures over a 13-year period) also revealed that “doggy style” sex – vaginal penetration from behind – was responsible for roughly a quarter of injuries, while 15 per cent were attributed to masturbation.
It also found that penile fractures were more common in heterosexual intercourse, accounting for 64 per cent of reported injuries, compared to only 9 per cent from gay sex. The remaining incidents were sustained through a combination of “penis manipulation” and “unclear circumstances”.
Other possible situations where penile fracture may occur include rolling over in bed onto an erect penis, hitting an erect penis and over-vigorous masturbation.
Penile fracture symptoms
The usual symptom of penile fracture is a cracking or popping sound – which can be quite loud – but others include:
significant pain
bruising and swelling – referred to as “the eggplant (aubergine) deformity” where the penis becomes purple and swollen.
bleeding from the penis or blood in the urine
It appears that if there is nor popping sound, or sudden loss of the erection then it is unlikely that a fracture has occurred and that another cause is likely such as a ligament rupture or a broken blood vessel.
When to see a doctor
A penile fracture should always be considered a medical emergency and so urgent medical advice should be obtained rather than the condition being ignored or left alone. The reason for this is that, if left untreated, it has the potential to damage both sexual performance and urinary function in the long-term. The quicker a penile fracture is treated the greater the chances of a full recovery occurring.
Penile fracture diagnosis
In many cases the diagnosis can be reached simply from the history and a careful examination but in some people further tests may be required. These include:
An ultrasound scan of the penis
A magnetic resonance image (MRI) scan of the penis if an ultrasound scan is inconclusive
Cavernosography, where a dye is injected into the blood vessels of the penis to see if there is any leakage of blood, or if the circulation is damaged.
Urinary tests to see if the urethra – the tube in the penis that urine passes through – has been damaged (this occurs in around a third of penile fractures).
Penile fracture treatment
Usually treatment for a penile fracture is surgical because this typically gives the best results in the long-term. The type of surgery depends on the extent of the injury and its aim is to repair any tears in the tunica albuginea and corpus cavernosum. This is done – typically, under general anaesthetic – by making an incision in the penis skin to access the damaged area and then stitching the tears closed. If the urethra is also damaged this is repaired and any blood clot that has collected in the penis is removed.
Leaving a penis fracture untreated can lead to a permanent deformity of the penis and an inability to have normal erections in the future. Surgery has a success rate of over 90 per cent, with a stay in hospital of around two to three days. Sexual activity is not recommended for at least a month and occasionally a doctor will advise that special splints are put around the penis in order to reduce pressure and aid healing. Follow-up checks and imaging studies will then take place to check on how well healing is occurring.
Penile fracture prevention
Always make sure there is adequate lubrication during sex – use lube if necessary – and always take care during very vigorous sex, particularly when the cowgirl or reverse cowgirl position is used.
Don’t grip your penis hard when masturbating and don’t bend it quickly – never try and bend it to reduce your erection. In addition, try not to turn over in bed too quickly if you’ve got an erection and don’t force an erect penis into tight underwear.
Last updated: 03-09-2020
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