Written by Dr Geoff Hackett, consultant in sexual dysfunction
What is penile injury?
|Fracture occurs when an abnormal force is applied to the erect penis.|
Injury or trauma to the penis can be accidental or deliberate.
Deliberate penile injury is a particularly violent event that is usually self-induced or inflicted by a jealous partner or their former lover.
Despite the publicity surrounding a case of penile amputation in the USA, deliberate penile injury is rare in Western cultures, but seen more often in the Far East. Common injuries are:
- penile amputation
- penile fracture.
Fracture of the penis
Fracture occurs when an abnormal force is applied to the erect penis.
The 'fracture' is actually a tear in the tunica albuginea, the thick fibrous coat surrounding the corpora cavernosum tissue that produces an erection.
It's an uncommon injury, usually but not always the result of damage to the penis during sexual intercourse.
Most cases (75 per cent) occur on one side, 25 per cent affect both sides and in 10 per cent the tear extends into the urethra.
What are the symptoms of penile fracture?
- A 'cracking' noise.
- Immediate loss of erection.
Bleeding from the urethra may occur if the urethra is damaged.
How is penile fracture treated?
Advice should be sought quickly. Key elements in treating a fractured penis are:
- pain relief
- ice packs (always cover with a cloth before applying to skin)
- anti-inflammatory drugs.
This regime has satisfactory results in about 80 per cent of patients but in the rest, residual pain and deformity may lead to difficulty with sex.
These patients need a urethrogram (a test that shows whether the urethral tube is intact) to exclude urethral damage.
If the urethra is not damaged, any collection of blood (haematoma) is drained and repair is carried out to the damaged corpora and tunica. One report of a series of 17 repairs showed that after surgery all patients had painless erections and comfortable sex; only two patients were left with angulation ('bent' penis).
Urethral injuries should always be repaired but urethral stricture (narrowing) occurs long term in up to 20 per cent of men after surgery.
The traumatic removal of part of the penis, or the entire penis, is usually associated with severe rage, jealousy or psychiatric disturbance.
Acute blood loss may be considerable and life threatening, particularly with amputation of the erect penis. Successful outcome of surgery is closely related to the viability (capacity to stay alive) of the severed portion, so the part should be recovered and surgical advice sought as quickly as possible.
The aim of surgery is to restore penile length and the different functions of the penis if possible. Because the nerves to the erectile tissue are not usually damaged, erectile function is frequently maintained.
Microsurgery (fine surgery done with the surgeon looking down a microscope) is necessary to restore any degree of feeling.
Compared with other forms of reconstruction, microsurgery offers the best chance of having an adequately functioning urethra (tube in the penis used for urination and ejaculation).
Particular care must be taken to reconnect the veins, especially the deep dorsal vein, to restore venous drainage and prevent swelling and compromised blood flow after the operation.
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