Penile Trauma
While the penis is one of the least injured organs, it too is occasionally injured. What can put it at risk? And how is it repaired? The following information should tell you when it is imperative to see your doctor about problems.
How does the penis normally function?
The two main functions of the penis are urinary and reproductive. Inside the penis there are three tubes. One is called the urethra. It is hollow and allows urine to flow from the bladder through the penis and to the outside. The two other tubes are called the corpora cavernosa, spongy tubes that are soft until filled with blood during an erection. The three tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea. At the time of sexual activity the erection of the penis allows it to be inserted into the woman's vagina. In this situation, the urethra acts as a channel for semen to be ejaculated into the vagina to allow conception and pregnancy.
What are the causes and symptoms of penile injury?
The penis is injured much less frequently than other parts of the body such as the abdomen, legs, arms and head. However, it can be wounded as a result of various injuries, including automobile accidents, gunshot wounds, burns, or sexual activity.
Perhaps the most common injury to the penis occurs during sexual activity. When not erect, injury to the penis is rare because of the mobility and flexibility of the organ. During an erection, arterial blood flow causes the penis to become rigid. During vigorous thrusting, the erect penis may accidentally slip out of the vagina. The penis may accidentally strike the outside of the woman instead of being reinserted into the vagina. The penis may then bend sharply despite the erection. A typical sign of this problem is a sharp pain in the penis possibly a "popping" sound, and frequently a rapid loss of the erection. The pain and sound are produced by a tear of the tunica albuginea, which is stretched tightly during the time of an erection. Although there is no bone in the penis, urologists frequently refer to the injury as a penile "fracture." The pain may last for a short time or it may continue. The penis develops a collection of blood under the skin called a hematoma, and the penis may become quite swollen and badly bruised. Blood seen at the tip of the penis or in the urine is a sign of a serious injury to the urethra.
Further injuries can occur if a man places a rubber tube or other constricting device around the base of the penis that is too tight or on for too long. Rings or other objects made of rigid material such as plastic or metal should never be placed around the penis as they become stuck if the penis swells further. Cutting off the blood supply, these items can cause permanent damage to the penis if the blood supply is blocked for too long.. Also, the urethra and/or penis may be damaged if objects are put into the tip of the penis.
How are injuries to the penis treated?
If a person sustains a penile injury, a urologist will take a thorough medical history and complete a physical examination along with blood and urine tests. The focus of any initial examination is to diagnose the injury and assess the damage to the penis. If the doctor suspects an injury to the urethra, he/she may perform a procedure to view the urethra with a fiber optic camera. Another study might be an X-ray study call a "retrograde urethrogram" performed by injecting a special solution used with X-ray studies through the opening at the top of the penis and then taking X-rays. If the X-ray shows any leakage outside the urethra, it may indicate damage to that part of the urinary tract. Additional imaging techniques might include an ultrasound of the penis or an MRI.
Historically, treatment for a penis "fractured" during sexual activity was non-surgical management (e.g., cold compresses, pressure dressings, penile splinting and anti-inflammatory medications). Today, the treatment of choice is usually surgery since it has lower rates of infection, erectile dysfunction, and penile scarring and curvature. The most common surgical technique is to make an incision around the shaft near the head of the penis and pull back the skin to the base to examine the inner surface. The surgeon will then remove blood clots to help find any tears in the tunica albuginea. If tears exist, they are repaired before the skin is sewn back into position. A catheter may be placed through the penile urethra into the bladder to drain urine and allow the penis to heal. With the entire penis bandaged, the patient may remain in the hospital for one or two days, and go home with or without the catheter. They may be given antibiotics and pain medication and will probably be asked to make a follow-up office visit with their doctor.
For the rare injury of a traumatic amputation of the penis, the amputated portion should be wrapped in gauze soaked in sterile saline solution and placed in a plastic bag. The plastic bag should then be put into a second bag or cooler with an ice water slush. Under no circumstances should any amputated organ be placed directly into ice water. The water and direct contact with ice is harmful to tissue. If reattachment of the penis is possible, the lower temperature produced by the slush will increase the likelihood of successful reattachment. Penile reattachment even after 16 hours may be possible.
For massive injuries to the penis, major reconstruction is frequently possible by urologists experienced with this difficult surgery. How closely the reconstructed penis can return to normal urinary or sexual function varies greatly.
What can be expected after treatment for injuries to the penis?
Most cases of fractured penis caused by sexual activity and most other minor penile injuries will heal without problems if treated promptly. However, complications can and do occur. Possible complications include: infection, erectile dysfunction due to blockage of the nerve or blood supply to the penis, priapism in which the penis becomes erect and stays erect to the point of pain, or curvature of the penis after the injury has healed.. Failure of return of sufficient sexual function is rare but depends upon the degree of injury to the arteries, nerves and corpora cavernosum and whether the patient was experiencing erectile dysfunction just prior to the injury.
Frequently asked questions:
Although uncommon, large hospitals may see several penile injuries each year.
How do I prevent penile injury?
Penile injuries related to sexual intercourse can be prevented in most cases if your partner is simply aware of the possibility. Classically, penile "fractures" occur with the female partner on top. If your penis is erect and inadvertently slips from the vagina of your partner, stop the thrusting immediately. For other injuries, caution on the job, especially near machinery, defensive driving and gun safety are obvious precautions for the other types of injuries.
Reviewed January 2011
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