A penile fracture is a rare and alarming injury that may occur during sexual intercourse.
A penile fracture is not the same as a break in a bone. Instead, it is a rupture in the two areas of the penis responsible for erections: the corpora cavernosa and the penile sheath.
Because the injury can cause long-lasting damage to a man's sexual and urinary function, it is important to seek emergency medical attention.
A penile fracture is a painful injury that usually occurs in the lower two-thirds of the penis.
Symptoms of a penile fracture include:
- bleeding from the penis
- experiencing dark-colored bruising to the penis
- having trouble urinating
- hearing a cracking or popping sound
- losing an erection suddenly
- pain that varies from minimal to severe
A penile fracture will often cause the penis to take on what doctors call an "eggplant deformity," where the penis appears purple and swollen. Rarer symptoms of a penile fracture include swelling in the scrotum and blood in the urine.
Other conditions that mimic the symptoms of a penile fracture include a rupture of the veins and arteries in the penis and a ruptured suspensory ligament.
A doctor can use imaging techniques and conduct a physical exam to determine the difference between the conditions.
The penis has an area of sponge-like tissue called the corpus cavernosa. When a man has an erection, the blood in the penis concentrates in this area. When the penis is erect, one or both sides of the corpus cavernosa can snap, resulting in a penile fracture.
A penile fracture will usually only occur when a man's penis is erect. A flaccid penis does not typically fracture because the corpus cavernosa is not as enlarged as when the penis is erect.
The injury usually happens when a man is thrusting against the pubic bone or the perineum, which can cause the corpus cavernosum to snap or break.
Men are not necessarily having rough sex when a fracture occurs, but may be in a position where the penis is more likely to hit against a bone.
However, a penile fracture has also been known to occur in the following circumstances:
- rolling over in bed onto an erect penis
- hitting an erect penis on something, such as a door frame or furniture
- falling onto an erect penis
If a man suspects he has a fractured penis, he must seek immediate medical attention.
Doctors consider a penile fracture a urological emergency because it has the potential to affect a man's sexual and urinary function permanently.
Most men will seek treatment at an emergency department. The faster a man can see a doctor and have the fracture treated, the more likely he is to experience a full recovery.
A doctor can typically diagnose a penile fracture by asking questions about how the fracture occurred and inspecting the penis.
Imaging studies, such as an X-ray, may also be used. Also, a doctor may use an ultrasound, which uses sound waves to detect abnormalities and locate the exact area or areas where the penis was damaged.
If a doctor cannot identify the tear using ultrasound, they may use magnetic resonance imaging (MRI) instead.
Treatments for a penile fracture can include at-home care and surgical repair.
At-home treatments include:
- Applying cloth-covered ice packs for 10 minutes at a time to reduce swelling.
- Using a Foley catheter to empty the bladder and reduce trauma to the penis.
- Taking anti-inflammatory medications, such as ibuprofen, to reduce pain and swelling.
Occasionally, a doctor will also recommend wrapping the penis or wearing special "splints" to position the penis in a way that reduces pressure.
Using at-home treatments alone has been shown to cause high rates of complications following a penile fracture. Examples of these include pain when getting an erection, a severe angle to the penis, and inability to achieve an erection.
As a result, many doctors recommend surgical repair and treatment. According to some research, surgery results in better outcomes for people with penile fractures.
Surgical treatment can vary based on the extent of a man's injuries. Examples of repairs that may be made after a penile fracture include:
- getting rid of a hematoma or buildup of blood due to the fracture
- stopping bleeding of any damaged blood vessels
- closing any cuts or lacerations to the penis that may be causing bleeding.
If a man's urethra is also damaged, a doctor may need to repair it as well.
To repair the penile fracture, a doctor will make an incision in the skin of the penis to access the one or more torn areas. The surgeon will repair these tears with stitches.
If a man does not seek treatment for a penile fracture, it is possible that he could experience a permanent penile deformity.
An untreated penile fracture may also lead to difficulty maintaining an erection, which is known as erectile dysfunction.
The ease of recovery following a penile fracture usually depends on the severity of the injury. While most men will be able to go home after the procedure, a doctor will usually advise them to refrain from sexual activity for at least 1 month to allow the surgical site to heal.
In rare instances where a man has difficulty avoiding an erection for the duration of the recovery period, a doctor may prescribe medications to reduce the likelihood an erection, such as sedatives or hormones.
Prompt treatment of a penile fracture is vital to ensure a man can return to his full sexual and urinary function.