Is a Penile Fracture an Emergency?

A penile fracture is an uncommon injury that results due to the rupture of the tunica albuginea of the penis, which is a tough fibrous sheath that lines the erectile bodies (corpora cavernosa) of the penis.

The penis acts as the passageway for semen and urine, containing three tube-like structures: the urine channel (urethra) and two spongy tubes called corpora cavernosa, which are soft until they get filled with blood during an erection.

A penis is quite flexible when not erect, however, when erect, a penile fracture results when the penis is abruptly and forcefully bent. Because there are no bones in the penis, a penile fracture does not involve a fracture of any bones. These fractures are accompanied by urethral injury in about 20 percent of cases.

A penile fracture typically results in a sudden loss of erection (detumescence), though it is unlikely to happen in the absence of a sudden detumescence. It is accompanied by severe pain with some men reporting an audible “pop” or “crack” when the fracture occurs.

The penis may appear swollen and discolored (blue to purple) due to the accumulated blood, which is called the eggplant deformity of the penis. There may be bleeding through the opening of the urethra (urethral meatus) when there is an associated urethral injury. Other symptoms may include difficulty urinating or blood in the urine (hematuria).

Typically penile fractures occur for the following reasons:

• When an erect penis is injured
• During vigorous sexual intercourse or masturbation
• When the penis accidentally hits the partner’s perineum or pubic bone during vaginal sex
• In certain ethnicities when they practice “taqaandan” (involves manually bending the erect penis to achieve detumescence)
• During penetrative anal intercourse
• During sleep when a man rolls over an erect penis

The treatment of a penile fracture mainly depends on the extent of the injury. In minor cases when the tunica albuginea is not ruptured, nonoperative management using pain medications (analgesics) and cold compresses is generally sufficient.

Surgical exploration is necessary if the tunica albuginea is damaged. This surgery involves draining the collected blood (hematoma) and repairing the tunica. Surgery can also identify any injuries of the urethra and repair them at the earliest.

Surgeries for penile fracture generally do not involve a prolonged hospital stay. Most patients are discharged on the same day after the surgery. They are, however, advised to avoid sex for about four weeks. Timely management of penile fractures generally results in a good prognosis both structurally and functionally.