Posts Tagged ‘tunica albuginea’

Thankful for Tough Tissues: Big Head/ Little Head

August 4, 2018

Andrew Siegel MD   8/4/2018

Midas penis in cage

Image above from Phallological Museum in Reyjkavik that I recently visited

 

The toughest connective tissues in the human body, exclusive of bone and teeth (in order of strength) are:

  1. Dura mater (of brain and spinal cord)
  2. Tunica albuginea (of penis and clitoris)

Is it not fitting that the two toughest and hardiest connective tissues in the human body are located in the brain and genitals, providing protection and support to arguably two of our most vital and important human possessions? 

The hardest organs in the body are bones (calcium and other minerals) and teeth (enamel), but when it comes to connective tissue, the brain and penis/clitoris reign supreme. The brain and spinal cord are enveloped and protected by the dura mater (Latin, “hard mother”), the robust outermost membrane. The erectile chambers of the penis (and the clitoris, although on a miniaturized scale) are covered with a tough fibrous envelope called the tunica albuginea (Latin, “white membrane”).

The White Membrane

The tunica albuginea consists mostly of collagen with a sprinkling of elastin to allow it to stretch. It has an important role in maintaining both penile and clitoral erections.  When a penis is flaccid the tunica is 2 mm or so thick and with an erection it stretches to 0.25 to 0.5 mm thick.  At the time of erectile rigidity, the blood pressure in the penis exceeds 200 mm of mercury, the only place in the body where hypertension is desirable and necessary for proper function. The tunica albuginea supports the penis at these times of penile hypertension, allowing for full erectile rigidity and durability and protecting the penis against injury from the torquing and buckling stresses of sexual intercourse.

Acute Trauma to the White Membrane

On rare occasions, the tunica surrounding the erectile chambers of the penis ruptures under the force of a strong blow to the erect penis, a situation referred to as a penile fracture. It is not unlike the tire of a car being driven forcibly into a curb, resulting in a gash in the tread and deflation from the blow out. Such an acute blunt traumatic injury rarely occurs to the non-erect penis by virtue of its mobility, flaccidity, and 2 mm thick tunica. However, when the penis is rigid, there is peak tension and stretch on the white membrane. The leading cause of penile fractures is vigorous sexual intercourse, most often when the penis slips out of the vagina and strikes the perineum (area between the vagina and anus). She “zigs,” he “zags,” and a miss-stroke occurs of sufficient force as to rupture the white membrane.

Fracture can also occur under the circumstance of rolling over or falling onto the erect penis as well as any other situation that inflicts damage to the erect penis, such as walking into a wall in a poorly illuminated room or forcible masturbation.

Penile fracture is a medical emergency, and prompt surgical repair is necessary to maintain erectile function and minimize scarring of the erectile chambers that could result in permanent penile bending and angulation.

Chronic Trauma to the White Membrane

Chronic traumatic injuries to the white membrane are often asymptomatic for many years. Just the simple act of obtaining a rigid erection puts tremendous compression stress forces on the white membrane and the potential for micro-trauma to it increases exponentially when one inserts his erect penis into a vagina and two parties move, bump and grind, creating intense shearing stress forces on the penis. Certain positions angulate the penis and create more potential liability for injury than others. Even gentle sex can be rough with a single act of intercourse resulting in hundreds of thrusts with significant rotational, axial and torquing strains and stresses placed upon the erect penis with the potential for subtle buckling injuries.

Repeat performance perhaps a few times a week for many decades and by the time a man is in his 50s, on a cumulative basis, traumatic penile injuries—often asymptomatic in their developmental stages—can cause scarring to the white membrane, ultimately resulting in Peyronie’s disease.  This often manifests with a hard lump, shortening, curvature, narrowing, a visual indentation of the penis described as an hour-glass deformity, pain with erections and less erectile rigidity. Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse.

Bottom Line:  The human body is nothing short of amazing and should be accorded the greatest respect. We should be grateful for our dura mater and tunica albuginea that protect and allow function of our brains and penises/clitorides, respectively.  Given the service that our penises provide, it is surprising that penile fracture and Peyronie’s disease are not more common than they actually are.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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Breaking Bad: What You Need To Know About Penile Fracture

January 24, 2015

Andrew Siegel MD   1/24/15

The French term for a broken penis is faux pas du coit. Everything sounds more elegant in French, oiu? Call it what you want, this is one mishap you want to avoid!

DSC01443

(I took the above photo at Alcazar Palace in Seville, Spain)

What Is It?

Penile fracture is a rare urological emergency that requires prompt surgical repair. It is a dramatic occurrence that most often happens during sexual intercourse in which the tough sheath surrounding the erection chambers of the penis ruptures under the force of a strong blow to the erect penis. It is similar to the tire of a car being driven forcibly into a curb, resulting in a gash in the tread and an immediate flat tire. Even though there is no bone in the human penis, the term fracture is appropriate because the outer sheath cracks, resulting in a broken erection chamber of the penis.

How Does It Happen?

A flaccid penis is rarely traumatized. However, when a penis is erect, there is major tension on the sheath surrounding the erectile chambers. A penile fracture occurs when this outer tunic—already under internal stretch and tension by virtue of the expansion of the erection chambers—is further subjected to external blunt trauma. This usually occurs with vigorous sexual intercourse, most often when the penis slips out of the vagina and strikes the perineum (area between the vagina and anus) or the pubic bone, resulting in a buckling injury.

In other words, she “zigs” and he “zags,” and a forcible miss-stroke occurs, which ruptures the outer sheath housing the erection chambers. Fracture can also with rough masturbation, rolling over or falling onto the erect penis, and walking into a wall in a poorly lit room.

In Iran the practice of Taqaandan (Kurdish “to click”) is a cause of penile fractures. This is the practice of creating an audible click by bending the erect penis, comparable to cracking one’s knuckles, but not as harmless.

How Do You Know If You Have Fractured Your Penis?

It is a dramatic event…A popping sound occurs as the outer sheath ruptures, followed by excruciating pain, rapid loss of the erection, and purplish discoloration and extreme swelling of the penis, as the blood within the erection chambers escapes through the rupture site into the soft tissues of the penis.

MRI is useful to show the site, extent and anatomy of the fracture. Prompt repair in the operating room is important to maintain erectile function and minimize scarring of the erection chambers that could result in angulated erections. An injury to the urethra that accompanies the tear in the erectile sheath occurs in a small percentage of men. Even with immediate surgical repair, up to 20% of men will experience a penile curvature with erections and more than 30% will experience ED.

Bottom Line: Penile fracture most commonly occurs from a miss-stroke during sexual intercourse. Prompt attention with surgical repair is very important to help prevent sexual issues.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.

Fracture Of The Penis

December 15, 2012

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.

DSC01444 DSC01447

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.

DSC01443

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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