Andrew Siegel, M.D. Blog #86
The images below were taken on my recent trip to Seville, Spain at Alcazar Palace. The statue of the young man with the broken penis gave me the idea to do a posting on the subject of penile fracture.
The penis is an organ with an impressive ability to multi-task, having urinary, sexual and reproductive functions. As a urinary organ, it allows directed urination that allows men to stand to urinate and have a directed urinary flow, a very handy benefit, especially useful with respect to certain public restrooms. As a sexual and reproductive organ, the erect penis permits vaginal penetration and sexual intercourse and functions as a conduit for the placement of semen into the vagina, and hence DNA transfer and perpetuation of the species. No other organ in the body demonstrates such a great versatility in terms of the physical changes between its “inactive” versus “active” states.
Penile rigidity is on the basis of blood flow. The human penis has no bone, unlike the penis of many other mammals. The function of the “bony” or os penis in those mammals that have it is to facilitate sexual intercourse by maintaining penile rigidity. The female equivalent is the os clitoris, a bone in the clitoris that maintains rigidity, also not found in humans. The human penis obtains its bone-like rigidity (hence the slang term boner) by virtue of blood filling and inflating the spongy tissue within the two erectile cylinders of the penis (corpora cavernosa), similar to air inflating the tire of a car. Clitoral rigidity occurs in identical fashion, although on a much smaller scale.
Erections are necessary to make the penis rigid enough to achieve vaginal penetration. The price paid for penile rigidity is the small chance of an injury occurring when erect—as opposed to being flaccid, which is state that is protective against blunt injuries. A penile fracture is a rare but dramatic occurrence in which the outer sheath surrounding the erectile cylinders of the penis ruptures under the force of a strong blow to the erect penis. It is not unlike the tire of a car being driven forcibly into a curb, resulting in a gash in the tread. Even though there is no bone in the human penis, the term fracture is an appropriate term for the injury, because the outer sheath literally ruptures, resulting in a break of the integrity of the erectile cylinders. A fracture of the penis is a medical emergency, and prompt surgical repair is necessary to obtain satisfactory cosmetic and functional results.
Blunt traumatic injuries rarely occur to the non-erect penis by virtue of its mobility and flaccidity. Blunt trauma to the penis is usually of concern only when the penis is in an erect state. When the penis is rigid, there is peak tension and stretch on the outer sheath. A penile fracture occurs when this outer tunic—already under internal stretch and tension by virtue of the expansion of the erectile cylinders—is further subjected to external blunt trauma. This usually occurs under the situation of vigorous sexual intercourse, most often when the penis slips out of the vagina and strikes the perineum (area between the vagina and anus, known in slang terms as the taint), sustaining a buckling injury.
In other words, she “zigs” and he “zags,” and a forcible miss-stroke occurs of sufficient magnitude as to rupture the outer sheath housing the erectile cylinders. Fracture can also occur under the circumstance of rolling over or falling onto the erect penis as well as any other situation that could inflict damage to the erect penis, such as walking into a wall in a poorly illuminated room or very forcible masturbation.
A penile fracture typically causes a rather classic and dramatic clinical scenario. An audible popping sound occurs as the outer sheath ruptures, followed by acute pain, rapid loss of erection, and purplish discoloration and extreme swelling of the penis, as the blood within the erectile cylinders escapes through the rupture site, similar to a blow-out of a car tire.
MRI can be used to demonstrate the precise site, extent and anatomy of the fracture. Penile fractures need to be promptly addressed in the operating room, as surgical repair of the injury is important in order to maintain erectile function and minimize scarring of the erectile cylinders that could result in penile bending and angulation. Essentially, the skin of the penis is temporarily de-gloved (peeled back like a banana skin) and the fracture is identified and repaired with sutures, after which the skin is reattached.
If allowed to heal on its own without surgical intervention, scarring will occur at the site of the fracture and many patients will develop a penile curvature with erections. As a result of the scar tissue, when an erection occurs, there is asymmetrical expansion of the erectile cylinders, resulting in a penile bend or deviation that can be to the extent as to preclude or require extreme acrobatics to have sexual intercourse.
The long and the short of it is that penile fracture is a rare but serious occurrence; this emergency situation demands an expedient trip to the operating room to maintain satisfactory erectile function.
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
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