Everything you need to know about penile fracture

By Rachel Nall, RN, BSN, CCRN  

Reviewed by Alana Biggers, MD, MPH

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.

Symptoms

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

According to research, penile fracture symptoms that do not include a popping sound or rapid loss of erection are usually due to another type of injury.

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.

Causes

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.

According to one review, most cases of penile fracture in the United States occur during intercourse.

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

When to see a doctor

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.

Diagnosis

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.

Treatment

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.

Aftercare and recovery

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.

SOURCE: MEDICAL NEWS TODAY