Penile fracture

Content written by John P. Mulhall, MD

Although uncommon, the dramatic nature of penile fracture often garners the public’s interest. The penis itself does not possess a bone, however, the outer lining of the erection chambers (corpora cavernosa), the tunica, is a tough dense structure which allows the penis to obtain high levels of rigidity. When the penis is abruptly torqued, this tissue ruptures and this is penile fracture. This is classically seen in a man following ‘partner on top’ position. in this scenario sometimes the penis exits the vagina, and the woman brings her body weight down upon the penis bending it abruptly. This results in a tear in the tunica, leading to rapid loss of erection, followed by massive bleeding under the penile skin (hematoma). It is common for men with penile fracture to go to the emergency room in a delayed fashion, largely related to the embarrassment associated with the injury. It is generally accepted that the standard treatment for penile fracture is surgical repair. If this fails to happen it is probable that the patient will develop scar at the site of the injury leading to penile curvature.

Penile fracture may cause erectile problems in two ways. First, due to the degree of curvature, men are often distressed by the appearance of the penis and this may lead to weakening of erection and in severe cases, the degree of curvature maybe so significant that vaginal penetration is difficult or impossible. The second way by which penile fracture results in erectile problems relates to the anxiety level that many men possess after this injury. During their next sexual encounters they are fearful of reinjuring their penis and this fear and anxiety leads to high levels of adrenaline in the body and penis. Adrenaline being the world’s most potent anti-erection chemical leads to difficulty obtaining erection as well as maintaining erection.