While the penis contains no bone, the term “penile fracture” is used to describe a severe traumatic injury. The correct medical term is a rupture of the tunica albuginea, the fibrous sheath responsible for maintaining rigidity. This injury occurs when the erect penis is subjected to sudden, forceful bending, tearing this sheath. A penile fracture is a urological emergency requiring immediate attention due to the high-pressure rupture of internal tissue.
What Is a Penile Fracture?
The penis contains three internal cylindrical chambers: two large corpora cavernosa on the top, and the corpus spongiosum underneath. During an erection, these chambers fill with blood, causing the penis to become rigid. The corpora cavernosa are surrounded by a dense, protective layer of fibrous connective tissue called the tunica albuginea.
When the penis is erect and engorged with blood, the tunica albuginea thins considerably. This thinning, combined with the extreme pressure inside the chambers, makes the tissue susceptible to tearing if the erect penis is suddenly bent. A penile fracture is defined as the traumatic tear or rupture of one or both of these tunica albuginea layers.
The rupture typically occurs when a blunt force is applied, often when the penis slips out during intercourse and strikes against a partner’s pubic bone. This mechanism subjects the thin, pressurized tissue to a force it cannot withstand. The injury is almost exclusively limited to the erect state, as the flaccid penis is flexible and highly resistant to this type of trauma.
Immediate Signs and Symptoms
The onset of a penile fracture is marked by a distinct set of physical signs. The most immediate indicator is often an audible sound, described as a sudden “pop” or cracking noise, which signifies the moment the tunica albuginea tears. This sound is instantly followed by severe, intense pain at the site of the injury.
The erection is lost rapidly (detumescence) as blood leaks out of the torn chamber. The escaped blood pools beneath the skin, causing rapid swelling and noticeable discoloration. This bruising can cause the penile shaft to appear dark purple or black, often leading to an abnormal shape known as the “eggplant deformity.”
In some cases, the injury may also involve the urethra. If the urethra is damaged, symptoms may include blood at the tip of the penis or blood in the urine. Recognizing the classic combination of a popping sound, immediate pain, and rapid swelling is usually sufficient for a clinical diagnosis.
Emergency Action and Medical Treatment
A suspected penile fracture constitutes a urological emergency requiring urgent transportation to a hospital. Delaying medical attention significantly increases the risk of long-term complications. Diagnosis is often confirmed through a physical examination, though imaging like ultrasound may be used to precisely locate the tear in the tunica albuginea.
The definitive treatment for a penile fracture is immediate surgical exploration and repair. During the procedure, the surgeon makes an incision to access the injury site and evacuates the pooled blood (hematoma). The ruptured edges of the tunica albuginea are then closed using absorbable sutures to restore the structural integrity of the erectile chamber.
Surgical repair is the standard of care because non-surgical management is associated with a higher rate of complications. Timely intervention, ideally within 24 hours, is important for preserving functional outcomes. The surgeon will also inspect for and repair any simultaneous injury to the urethra.
Recovery and Potential Complications
Following successful surgical repair, patients typically spend a short period in the hospital. Recovery involves managing bruising and swelling, which can persist for several weeks, and adhering to instructions to ensure proper healing. Patients are advised to avoid sexual activity and any instance that could cause an erection for at least four to six weeks, or until a urologist gives clearance.
While prompt surgery yields favorable outcomes, potential long-term complications exist, particularly if treatment is delayed. A significant concern is the development of erectile dysfunction (ED), involving difficulty achieving or maintaining an erection firm enough for intercourse. Men who do not undergo immediate repair have a significantly higher rate of ED compared to those who receive timely surgery.
Another potential complication is Peyronie’s disease, characterized by the formation of scar tissue that causes a painful, abnormal curvature of the penis during erection. The risk of developing Peyronie’s disease is notably reduced when immediate surgical repair is performed. Long-term follow-up with a urologist is important to monitor for these issues, including a palpable nodule or persistent pain during erection.