A penile fracture is a serious urological emergency requiring immediate medical attention. Despite its name, this injury does not involve a bone, as the penis contains no skeletal structure. The term refers to the rupture of the fibrous casing surrounding the erectile tissue. This traumatic event can have severe long-term consequences if not treated swiftly.
What Defines a Penile Fracture
The penis contains three cylindrical structures of spongy tissue: two larger ones on top called the corpora cavernosa, and a smaller one underneath called the corpus spongiosum, which surrounds the urethra. The corpora cavernosa are responsible for an erection, filling with blood to achieve rigidity. Each of these erectile bodies is encased in a thick, protective sheath of connective tissue known as the tunica albuginea.
A penile fracture occurs when the erect penis is subjected to blunt trauma, causing a sudden, forceful bend against a hard surface. During an erection, the tunica albuginea becomes significantly thinner and stiffer, making it vulnerable to tearing when internal pressure is high. The tear in this casing allows blood to rapidly escape from the cavernous body, which constitutes the “fracture.” The most common cause is vigorous sexual activity, often when the penis slips out and strikes the partner’s pelvic bone or perineum.
The Immediate Signs of Injury
When a typical penile fracture occurs, the initial signs are unmistakable. The event is frequently accompanied by a sudden, audible “popping” or “cracking” sound, which is the noise of the tunica albuginea tearing. This is immediately followed by the rapid and complete loss of the erection, a process known as detumescence.
Intense and immediate pain is a near-universal symptom, as is the rapid development of swelling and dark bruising, or hematoma. This collection of blood beneath the skin, often contained by the deeper fascial layers, can cause the penis to swell and deform into a characteristic shape sometimes called the “eggplant deformity.” In about 10 to 22 percent of cases, the urethra, which runs through the corpus spongiosum, may also be injured, signaled by blood at the tip of the penis or in the urine.
Can a Penile Fracture Go Unnoticed
While the classic presentation is unmistakable, it is possible for a penile fracture to be initially overlooked or misdiagnosed, though this is rare. The possibility of an unnoticed injury usually relates to partial tears of the tunica albuginea, where the rupture is smaller or less severe. In these less dramatic scenarios, the characteristic popping sound may not be heard, or the resulting pain and swelling may be mild or delayed, leading the injured person to mistake it for a simple strain or contusion.
A delay in seeking treatment can also occur due to embarrassment or a belief that the symptoms will resolve on their own with rest. However, even a small tear requires repair to prevent complications, so assuming a minor injury based on mild symptoms is ill-advised. There are also rare instances where an underlying nerve issue could alter pain perception, making the injury less immediately painful. When symptoms are atypical or mild, diagnostic imaging like an ultrasound or MRI may be necessary to confirm the diagnosis and determine the extent of the damage.
The Necessity of Immediate Medical Evaluation
Regardless of the severity of the initial symptoms, immediate medical evaluation is necessary for any suspected penile fracture. The timing of intervention directly impacts the long-term prognosis. A healthcare professional will typically diagnose the fracture through a physical exam and a detailed history of the traumatic event, which is often sufficient due to the classic signs.
The standard treatment for a confirmed penile fracture is immediate surgical repair, ideally performed within 24 hours of the injury. During the procedure, the surgeon evacuates the hematoma and stitches the tear in the tunica albuginea, sometimes also repairing any associated urethral injury. Delaying surgical repair increases the risk of long-term complications. Untreated fractures can lead to the formation of scar tissue, resulting in a permanent curvature known as Peyronie’s disease. Other potential long-term issues include chronic pain during erection and erectile dysfunction.