A penile fracture is an injury to an erect penis, representing a serious urological emergency that requires prompt medical evaluation. The term “fracture” is a misnomer, as there are no bones in the penis. The injury is actually a tear or rupture of a specific layer of tissue called the tunica albuginea. This fibrous sheath surrounds the corpora cavernosa, the two columns of spongy tissue that fill with blood to produce an erection. When the penis is erect, the tunica albuginea thins and stretches, making it more susceptible to tearing from sudden, forceful bending.
Symptoms and Common Causes
The signs of a penile fracture are typically immediate and distinct. Many individuals report hearing an audible “popping” or “cracking” sound at the moment of injury. This sound is immediately followed by intense pain, a rapid loss of the erection, and significant swelling. As blood from the ruptured erectile chamber escapes into the surrounding tissue, prominent bruising develops, which can cause the penis to take on a swollen, discolored appearance often referred to as the “eggplant deformity.” In some instances, the penis may also appear bent or deviated to one side.
This injury is caused by blunt force trauma to an erect penis. The most common cause is trauma during sexual intercourse, particularly when the penis slips out of the vagina and strikes the partner’s pubic bone or perineum. Certain sexual positions, such as when the partner is on top, are associated with a higher risk because the partner’s full body weight can forcefully bend the penis if a misalignment occurs. Aggressive masturbation and rolling over onto an erect penis during sleep are other reported causes.
Immediate Actions and Medical Diagnosis
If a penile fracture is suspected, seeking emergency medical care without delay is the most important step. Individuals should go to the nearest emergency department for evaluation by a medical professional. While en route, applying a cold compress, such as ice wrapped in a cloth, to the area can help manage swelling. Over-the-counter pain relievers may also be taken, but these measures are for temporary comfort and do not replace the need for professional medical treatment.
A diagnosis can often be made based on the patient’s description of the event and a physical examination. To confirm the diagnosis and assess the extent of the damage, a doctor may order imaging tests. An ultrasound is often used to visualize the tear in the tunica albuginea, while a magnetic resonance imaging (MRI) scan can provide more detailed images of the tissue damage. If there is blood at the opening of the penis or difficulty urinating, a urethral injury may be suspected, which might require further evaluation.
Surgical Repair and Treatment
The standard treatment for a penile fracture is prompt surgical repair. Surgery performed soon after the injury, typically within 24 hours, is associated with better outcomes and a lower rate of long-term problems. The primary goals of the operation are to evacuate the collection of blood, known as a hematoma, and to precisely repair the tear in the tunica albuginea.
During the procedure, a surgeon makes an incision to access the site of the injury. After draining the hematoma, the edges of the ruptured tunica albuginea are identified and stitched together with absorbable sutures. If the urethra has also been injured, it will be repaired during the same operation. While non-surgical management—involving compression, catheterization, and pain medication—exists, it is rarely used. This conservative approach is generally reserved for patients who are not suitable candidates for surgery, as it is associated with much higher rates of complications like penile curvature and erectile difficulties.
Recovery and Potential Complications
The recovery period following surgical repair requires patience and adherence to medical advice. Most patients can return home the same day or the day after the procedure, though pain and swelling may persist for several weeks. To allow the repaired tissues to heal properly, patients are instructed to avoid all sexual activity, including masturbation, for at least a month, and often longer, based on the surgeon’s recommendation.
Delaying treatment or forgoing surgery can lead to a number of lasting complications. One of the most significant risks is the development of erectile dysfunction, which is the inability to achieve or maintain an erection sufficient for sexual activity. Another potential issue is the formation of scar tissue at the site of the tear, which can cause a permanent bend or curvature in the penis, a condition known as Peyronie’s disease. Chronic pain, particularly during erections, is another possible long-term consequence.