Ouch! Penile Injury

[Michael Scally MD]

Ozcan S, Akpinar E. Diagnosis of penile fracture in primary care: a case report. Cases J 2009;2:8065.

INTRODUCTION: Penile fracture has been reported with sexual intercourse, masturbation, rolling over or falling on to the erect penis. Classically the history is with a sudden snap, pain, detumescence and a hematoma of the penis with deformity. Immediate surgical treatment is recommended. The patients may delay the admission due to fear and embarrassment or the condition may usually be underreported.

CASE PRESENTATION: A 32-year-old man presented to primary care complaining of discoloration of penis without any significant history or symptom. Physical examination revealed swollen, ecchymotic, and deviated circumcised penis.

CONCLUSION: Although frequent and common diseases represent the majority of daily work, the primary care physician should be alert for possible unexpected history or symptom of a rare and often serious condition.

 

[BBC3]

Yea, I wonder how many primaries really have to reference that one? Funny I noticed how they mentioned "rolling over, or falling out of bed". RRRRRRRIIIIIIGGGGHHHHTTTT!!!!! I think they offer that as caviat type explaination for coaching and or documentation purposes of the leary COMMON FREAK....opcorn: Who the hell is going to trip and fall on a diamond cutter??!!?? What grown man is going to have one that hard that last throught the act of standing!!?? Shit, even it I do, I would not be able to get my hands off of it long enough to leave in vernerable..

So the truth is that anyone damaging their penis in this way, was most likely up to some pretty subversive behavior, hence "They fell out of bed"...... I cant stop... I mean, how many men are going to go to the doctor and tell him that his wife was hanging from the ceiling of their recently installed apparatus jackhammering the shit out of him, when her grip slipped??? I can't just imagine being a fly on the wall for that moment of explainatiion. Or better yet, he was stretching it with a rope and a weight, and this happened more likely. "fell out of bed"..........

There is always that one urban legend in high school. Unconfirmed.....

 

[TrainHard]

LMAO[)] BBC3 You crack me up sometimes.

On another note....lol.....okay...first still trying to figure out how the hell you'll get this rolling over in bed, that's a new one. Maybe this guy had on one hell of a tight pair of tighty whities consticting the movement up, and bam rolled over into hell...[)] Another reason why boxers are still the best.

Yea, I wonder how many primaries really have to reference that one? Funny I noticed how they mentioned "rolling over, or falling out of bed". RRRRRRRIIIIIIGGGGHHHHTTTT!!!!! I think they offer that as caviat type explaination for coaching and or documentation purposes of the leary COMMON FREAK....opcorn: Who the hell is going to trip and fall on a diamond cutter??!!?? What grown man is going to have one that hard that last throught the act of standing!!?? Shit, even it I do, I would not be able to get my hands off of it long enough to leave in vernerable..

So the truth is that anyone damaging their penis in this way, was most likely up to some pretty subversive behavior, hence "They fell out of bed"...... I cant stop... I mean, how many men are going to go to the doctor and tell him that his wife was hanging from the ceiling of their recently installed apparatus jackhammering the shit out of him, when her grip slipped??? I can't just imagine being a fly on the wall for that moment of explainatiion. Or better yet, he was stretching it with a rope and a weight, and this happened more likely. "fell out of bed"..........

There is always that one urban legend in high school. Unconfirmed.....

 

[BBC3]

Well I mean think about it. I have been a teen. Shit I am one again lately for that matter and libido wise. I did everything I could imagine to that badboy and never managed to injure it!!! Hell I've bent it intentionally before just to try to achieve a desired shape or style.[)] I've spanked it a warp 7 plus. Squeezed, twisted, the old two handed fire starter....... Shit I think I ever applied electricity to it at one time..... Those were some seriously fun days!!!!

BUT I NEVER FREAKING BROKE IT.

Having a good fundamental understanding of human nature. and our hippocritical society, I would speculate the following:

I would wager that 98% of all penis injuries had nothing to do with sex, or even masturbation for that matter. Further it would be my guess that an injury like that can not occur due to a bending action. It would seem to be an injury of impacted force to the affected side. So here it is: I AM BETTING THAT ALL OF THESE INJURIES ARE THE RESULT OF SOME KIND OF ATTEMPT TO INCREASE ONE'S SIZE.!!!!!!!! And NEVER admitted.

LMAO[)] BBC3 You crack me up sometimes.

On another note....lol.....okay...first still trying to figure out how the hell you'll get this rolling over in bed, that's a new one. Maybe this guy had on one hell of a tight pair of tighty whities consticting the movement up, and bam rolled over into hell...[)] Another reason why boxers are still the best.

 

[Jeton]

this comes in different degrees. about 2.5 years ago i was jackhammering some self-proclaimed S&M bottom doggy (all in/all-out) and he flinched sideways while i was at peak speed. YIIIIKKKESS!!!!! came the pain as my dick bent hard. i ended the encounter immediately n went home. within a couple of hours i checked and my dick was all black n blue...it went away in about a week tho. the guy wrote me a few times later, i reminded him what happened and he's all "naw, no way man, i'd never do that to a guy!".and i'm like "DUDE, TRUST ME, THERE'S NO FUKN CHANCE IN HELL I'D EVER FORGET YOU!! UNLESS I IMMOBILIZE U N FILL U FULL OF ROOFIES, WE'RE DONE."


it can get a lot worse. years ago Dennis Rodman relayed to Howard Stern live on-air his grim tale of bouncing a chik up n down on his cock n suddenly she hit it wrong, and SHE BROKE HIS PENIS IN HALF!!! "blood spraying everywhere, agony agony, felt like blacking out"...he got some surgery and is now back to full health, supposedly.

hey, if they could reattach John Wayne Bobbit's severed penis, they could surely fix Rodman's.


the lesson: BE CAREFUL WHO U FUCK, HOW U FUCK THEM, AND ESPECIALLY, HOW THEY MOVE IN RESPONSE.

 

[BBC3]

mMMMmmmmmmmm. HUH! My hippocracy has bounds after all. No bigotry intended. That was just pretty RAW in a turby TOPSEE world....

I am only saying that I am guessing you will be hard pressed to find true empathy from many here on that one. But props to the balls out shotgun approach as always......

this comes in different degrees. about 2.5 years ago i was jackhammering some self-proclaimed S&M bottom doggy (all in/all-out) and he flinched sideways while i was at peak speed. YIIIIKKKESS!!!!! came the pain as my dick bent hard. i ended the encounter immediately n went home. within a couple of hours i checked and my dick was all black n blue...it went away in about a week tho. the guy wrote me a few times later, i reminded him what happened and he's all "naw, no way man, i'd never do that to a guy!".and i'm like "DUDE, TRUST ME, THERE'S NO FUKN CHANCE IN HELL I'D EVER FORGET YOU!! UNLESS I IMMOBILIZE U N FILL U FULL OF ROOFIES, WE'RE DONE."


it can get a lot worse. years ago Dennis Rodman relayed to Howard Stern live on-air his grim tale of bouncing a chik up n down on his cock n suddenly she hit it wrong, and SHE BROKE HIS PENIS IN HALF!!! "blood spraying everywhere, agony agony, felt like blacking out"...he got some surgery and is now back to full health, supposedly.

hey, if they could reattach John Wayne Bobbit's severed penis, they could surely fix Rodman's.


the lesson: BE CAREFUL WHO U FUCK, HOW U FUCK THEM, AND ESPECIALLY, HOW THEY MOVE IN RESPONSE.

 

[Jeton]

mMMMmmmmmmmm. HUH! My hippocracy has bounds after all. No bigotry intended. That was just pretty RAW in a turby TOPSEE world....

I am only saying that I am guessing you will be hard pressed to find true empathy from many here on that one. But props to the balls out shotgun approach as always......

[)] thanks, but i've never been one to scour the internet for empathy...just information and amusement. i always fire my shotgun with my balls out.

 

[BBC3]

I of course, can not fire on one for being provactive in presentation. Just pointing out the actual gigawatts I think you spun up there!!!! Woah.... Touche

[)] thanks, but i've never been one to scour the internet for empathy...just information and amusement. i always fire my shotgun with my balls out.

 

[Michael Scally MD]

Penile Fracture Seems More Likely During Sex Under Stressful Situations

Penile fracture occurs when the "tunica albuginea" -- the fibrous membrane surrounding the tissue in the center of the penis -- is torn during the bending or buckling of an erect penis. It can result in erectile dysfunction if not surgically repaired. Of the 16 patients in the study, 50% admitted to having an extramarital affair when the penile fracture occurred.


Kramer AC. Penile Fracture Seems More Likely During Sex Under Stressful Situations. The Journal of Sexual Medicine. Penile Fracture Seems More Likely During Sex Under Stressful Situations - Kramer - 2011 - The Journal of Sexual Medicine - Wiley Online Library

Introduction.? The unusual event of penile fracture occurs when there is a disruption of the tunica albuginea surrounding engorged erectile tissue during aggressive sexual behavior. There is often an audible crack and rapid detumescence with subcutaneous hemorrhage that follows.

Aims.? Medical literature has described the etiology and treatment of penile fracture. We report the remarkably unusual social situations of a series of patients who sustained this unique injury.

Methods.? We conducted a retrospective chart review of 16 patients whose injury was severe enough to require surgical repair at the University of Maryland between 2007 and 2011. Particular attention was paid to the intake interview in the emergency department and the postoperative chart notes by the attending urologist to ascertain out-of-the-ordinary social situations in which the injury was sustained.

Main Outcome Measures.? The occurrence of penile fracture is sufficiently rare that the author was able to interact personally with most of the patients. The patients were remarkably forthcoming with the personal social dynamics of the sexual encounter.

Results.? Half of these penile fracture patients sustained the injury during an extramarital affair. Only three patients sustained the injury in a bedroom; the remainder was in out-of-the-ordinary locations for sexual intercourse, e.g., cars, elevator, the workplace, and public restrooms.

Conclusions.? Penile fracture patients appear to be a unique population of men who are having sexual intercourse under stressful situations. Extramarital affairs and out-of-the-ordinary locations appear common in patients sustaining this relatively rare injury.

 

[zkt]

I lost my balance and fell out a bed a while ago. Damn near broke my arm. Good thing I didnt land on my dick.

 

[Structure]

I love how the following line quietly appears in the first report, and has no explanation:

"In the Middle East, self inflicted fractures predominate"

Lesson #1: Do not declare a holy war on your dick.

 

[BBC3]

Well then I am here to tell you the west is DOOMED.... CAUSE I HAVE DONE EVERYTHING YOU CAN THINK OF to hurt my cock and had little success. I mean, really!! Short of a sledge hammer, I just cant imagine how that injury could possibly occur.!?!? Perhaps its a genetic propensity.. ?

I love how the following line quietly appears in the first report, and has no explanation:

"In the Middle East, self inflicted fractures predominate"

Lesson #1: Do not declare a holy war on your dick.

 

[Michael Scally MD]

Mechanisms Predisposing Penile Fracture [“Woman On Top”]
Mechanisms Predisposing Penile Fracture [“Woman On Top”]

 

[Michael Scally MD]

Amer T, Wilson R, Chlosta P, et al. Penile Fracture: A Meta-Analysis. Urol Int. http://www.karger.com/Article/FullText/444884

OBJECTIVES: To review the causes and management of penile fracture and to compare between surgical and conservative management as well as immediate and delayed interventions in terms of overall and specific complications.

METHODS: A search of all reported literature was conducted for all articles reporting on the management and outcomes of penile fractures. Full texts of relevant articles were obtained and screened according to the inclusion criteria. Outcomes measures were numbers of patients receiving surgical or conservative management, aetiology of fracture, length of admission, complications as well as the specifics of diagnostic approaches and operative management. Data was collated and where possible meta-analysed using Revman software.

RESULTS: A total of 58 relevant studies involving 3,213 patients demonstrated that intercourse accounts for only 48% of cases with masturbation and forced flexion accounting for 39%. Meta-analysis shows that surgical intervention was associated with significantly fewer complications vs. conservative management (p < 0.000001).

Surgical intervention results in significantly less erectile dysfunction (ED), curvature and painful erection than conservative management. There was no significant difference in the number of patients developing plaques/nodules (p = 0.94). Meta-analysis shows that overall early surgery is preferable to delayed surgery but that rates of ED are not significantly different.

DISCUSSION: Early surgical intervention is associated with significantly fewer complications than conservative management or delayed surgery. The combined outcome of rapid diagnosis by history and clinical examination and swift surgical intervention is key for reconstruction with minimal long-term complications.

 

[Kakarot]

Heard and felt an odd popping sensation near the base awhile back. Sore for a couple of weeks but I didn't notice any bruising. Works fine now. Wonder if this is what happened?

 

[Dr JIM]

this comes in different degrees. about 2.5 years ago i was jackhammering some self-proclaimed S&M bottom doggy (all in/all-out) and he flinched sideways while i was at peak speed. YIIIIKKKESS!!!!! came the pain as my dick bent hard. i ended the encounter immediately n went home. within a couple of hours i checked and my dick was all black n blue...it went away in about a week tho. the guy wrote me a few times later, i reminded him what happened and he's all "naw, no way man, i'd never do that to a guy!".and i'm like "DUDE, TRUST ME, THERE'S NO FUKN CHANCE IN HELL I'D EVER FORGET YOU!! UNLESS I IMMOBILIZE U N FILL U FULL OF ROOFIES, WE'RE DONE."


it can get a lot worse. years ago Dennis Rodman relayed to Howard Stern live on-air his grim tale of bouncing a chik up n down on his cock n suddenly she hit it wrong, and SHE BROKE HIS PENIS IN HALF!!! "blood spraying everywhere, agony agony, felt like blacking out"...he got some surgery and is now back to full health, supposedly.

hey, if they could reattach John Wayne Bobbit's severed penis, they could surely fix Rodman's.


the lesson: BE CAREFUL WHO U FUCK, HOW U FUCK THEM, AND ESPECIALLY, HOW THEY MOVE IN RESPONSE.

Sounds like that's dudes ass was legitimate "virgin" territory, your first go with a PDE5 or both, lol!

 

[Michael Scally MD]

[Open Access] 3T MR-Guided Minimally-Invasive Penile Fracture Repair

We present the case of a twenty-one year-old Caucasian male presented to our emergency department with an asymmetric penile swelling, penile-scrotal hematoma, and severe localized pain. The patient reported a cracking sound followed by sudden pain and rapid detumescence of the penis after violent masturbation 48 hours before presenting to the emergency room.

The diagnostic assessment was performed first clinically, then with ultrasound and with 3 Tesla MRI. 3 Tesla MRI, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, we were able to perform a selective minimally invasive surgical approach to repair the lesion.

Rosi G, Fontanella P, Venzi G, Jermini F, Del Grande F. 3T MR-guided minimally-invasive penile fracture repair. Arch Ital Urol Androl 2016;88(1):68-9. http://www.pagepressjournals.com/index.php/aiua/article/view/aiua.2016.1.68/5065

 

[Michael Scally MD]

Sharma D, Kumar M, Pandey S, Agarwal S. Penile fracture after priapism due to sildenafil ingestion: out of frying pan into the fire. BMJ case reports 2018;2018. https://casereports.bmj.com/content/casereports/2018/bcr-2018-226562.full.pdf / https://casereports.bmj.com/content/2018/bcr-2018-226562.long

A 36-year-old man presented to our department with complaints of swelling, pain and deformed penis for 2 days. He had a history of 100 mg sildenafil ingestion, following which he sustained a prolonged erection that persisted even after sexual intercourse. He tried vigorous masturbation to relieve it, but he failed. After this exercise, while he was sleeping, his child mistakenly fell over his erect penis, following which he developed sudden severe pain in his penis and lost tumescence.

On examination, he had swelling and ecchymosis on the right posterolateral aspect of his penis (figure 1). There was no haematuria or blood at meatus. On the basis of history and physical examination, a diagnosis of penile fracture was made. Ultrasound revealed a tear in the lateral wall of the right corpora cavernosa with a large haematoma.

The patient was taken for emergency exploration. Intraoperatively, a defect of approximately 1×1 cm was visualised in the lateral wall of the right corpora cavernosa with a large overlying haematoma (figure 2). The haematoma was evacuated and the corporeal tear was repaired. The patient was followed up at 3 and 6 weeks. He sustained normal erections and there was no residual deformity.

 

[T-Bagger]

Sharma D, Kumar M, Pandey S, Agarwal S. Penile fracture after priapism due to sildenafil ingestion: out of frying pan into the fire. BMJ case reports 2018;2018. https://casereports.bmj.com/content/casereports/2018/bcr-2018-226562.full.pdf / https://casereports.bmj.com/content/2018/bcr-2018-226562.long

A 36-year-old man presented to our department with complaints of swelling, pain and deformed penis for 2 days. He had a history of 100 mg sildenafil ingestion, following which he sustained a prolonged erection that persisted even after sexual intercourse. He tried vigorous masturbation to relieve it, but he failed. After this exercise, while he was sleeping, his child mistakenly fell over his erect penis, following which he developed sudden severe pain in his penis and lost tumescence.

On examination, he had swelling and ecchymosis on the right posterolateral aspect of his penis (figure 1). There was no haematuria or blood at meatus. On the basis of history and physical examination, a diagnosis of penile fracture was made. Ultrasound revealed a tear in the lateral wall of the right corpora cavernosa with a large haematoma.

The patient was taken for emergency exploration. Intraoperatively, a defect of approximately 1×1 cm was visualised in the lateral wall of the right corpora cavernosa with a large overlying haematoma (figure 2). The haematoma was evacuated and the corporeal tear was repaired. The patient was followed up at 3 and 6 weeks. He sustained normal erections and there was no residual deformity.

Hmm, his child fell over his erect penis?

 

[Michael Scally MD]

[OA] Diagnosis and Treatment of Penile Injury

Introduction: To evaluate the imaging accuracy in the diagnosis and clinical management of penile injury.

Materials and methods: From January 2010 to January 2020, 20 men (median age 40.2 years) were admitted to our Emergency Department with the diagnosis of penile injury; the penile trauma was related to sexual intercourse in 16 cases, masturbation in 3 cases and injury caused by the partner in 1 case.

All the patients underwent accurate medical history, clinical examinations and diagnostic imaging. Color Doppler ultrasound (CDU) evaluation was performed by Logiq E9 ecograph (General Electric; Milwaukee, WI) supplied with a linear probe small (7.5-10 MHz); magnetic resonance image (MRI) examination was performed within 3-24 hours from the trauma using a 1.5 Tesla scanner, (ACHIEVA 3T; Philips Healthcare Best, the Netherlands) performing pre-contrast and post-contrast multi-planar turbo spin-echo T1 and T2-weighted sequences.

Results: 15/20 (75%) men with high suspicion of the tunica albuginea rupture underwent surgical exploration; conversely, 5/20 (25%) patients underwent conservative management. CDU detected 11/15 (73%) fractures of the penis and in 8 of them the length of the rupture was underestimated (more than 5 millimeters).

On the contrary, MRI diagnosed all the albuginea ruptures showed by surgical exploration, but underestimated the length of the lesions in 9/15 (60%) cases. The IIEF-5 score administered six months later penile trauma demonstrated a good performance in all the patients.

Conclusions: In our series, all the patients with a tunica albuginea rupture < 5 mm. diagnosed by MRI were submitted to conservative management with a complete functional restitutio ad integrum.

Panella P, Pepe P, Pennisi M. Diagnosis and treatment of penile injury: ten years experience of an emergency department. Arch Ital Urol Androl. 2020 Oct 1;92(3). doi: 10.4081/aiua.2020.3.192. PMID: 33016041. https://www.pagepressjournals.org/index.php/aiua/article/view/aiua.2020.3.192