Penile Fracture: Symptoms, Types, Causes and Treatment

Penile fracture is a rare but dramatic urological emergency that can have significant physical, psychological, and functional impacts if not recognized and treated promptly. Despite the sensitive nature of the injury, timely understanding and management are crucial for a full recovery. In this article, we’ll explore the key symptoms, types, causes, and treatment approaches for penile fracture, drawing on current research and clinical experience.

Symptoms of Penile Fracture

When a penile fracture occurs, the symptoms are often sudden, unmistakable, and alarming to those affected. Recognizing these signs quickly is vital for seeking immediate medical attention and preventing long-term complications.

Symptom	Description	Frequency/Note	Source
Audible snap	"Snapping" or "popping" sound at injury	Classic presentation	1 2 3
Penile pain	Sudden, acute pain in the penis	Nearly universal	1 2 3
Rapid detumescence	Immediate loss of erection	Very common	1 2 3 8
Swelling	Rapid development of swelling/hematoma	Most common finding (97.5%)	2 6 7 8
Deformity	Bent, angulated, or "eggplant" appearance	Frequently seen	3 8
Discoloration	Bruising/ecchymosis of the penile shaft	Common	1 2 8
Urethral bleeding	Blood at the tip of the penis, difficulty urinating	Indicates possible urethral injury	2 3 8 12

Table 1: Key Symptoms

The Classic Presentation

Penile fracture most often presents as a constellation of symptoms that are hard to miss:

• Audible crack or pop: Many men describe hearing or feeling a sudden snap, pop, or crack at the moment of injury. This sound is due to the tearing of the tunica albuginea, the tough sheath surrounding the erectile tissue 1 2 3.
• Immediate pain and detumescence: Almost instantly, the erect penis becomes flaccid, accompanied by sharp pain. This loss of erection is a classic and nearly universal sign 1 2 3 8.
• Rapid swelling and bruising: Blood escapes from the torn erectile tissue, causing rapid swelling and a blue or purple discoloration, often referred to as the 'eggplant deformity' due to its characteristic shape and color 2 6 7 8.

Other Significant Symptoms

• Penile deformity: The penis may become bent or angulated at the site of injury, which is visually obvious and distressing 3 8.
• Urethral bleeding: In some cases, blood may be observed at the urinary opening, or there may be difficulty urinating. These signs point to a more severe injury involving the urethra and warrant even more urgent care 2 3 8 12.

Why Quick Recognition Matters

The abruptness and severity of symptoms often cause significant anxiety and embarrassment, which unfortunately can lead to delays in seeking medical help. However, the longer treatment is delayed, the higher the risk of complications such as erectile dysfunction, penile curvature, or urinary problems 3 8.

Types of Penile Fracture

Not all penile fractures are the same. The extent and location of the injury, as well as the involvement of other penile structures, determine the type and severity of the fracture.

Type	Key Features	Severity/Outcomes	Source
Unilateral fracture	Tear of tunica albuginea on one side	Most common, less severe	3 8
Bilateral fracture	Tears on both corpora cavernosa	More severe, higher risk	3 8
With urethral injury	Involvement of the urethra (partial/complete)	More complications	2 3 8 12
With vascular/nerve	Involvement of dorsal vessels/nerves	Rare, potential complications	3

Table 2: Types of Penile Fracture

Unilateral Versus Bilateral Fracture

• Unilateral fracture: The majority of cases involve a tear on just one side of the penis, typically affecting a single corpus cavernosum. This is generally less severe and associated with fewer complications 3 8.
• Bilateral fracture: Injuries affecting both corpora cavernosa are less common but carry a higher risk of associated urethral damage and more severe long-term outcomes 3 8.

Associated Urethral Injury

• Partial or complete urethral rupture: When the injury also involves the urethra, symptoms such as blood at the meatus or inability to urinate are seen. Urethral injuries require more complex surgical repair and carry a greater risk of long-term urinary and sexual dysfunction 2 3 8 12.

Vascular and Nerve Involvement

• In rare cases, the dorsal nerve and blood vessels of the penis may also be injured, leading to additional complications such as numbness or impaired blood flow 3.

Diagnostic Considerations

Most penile fractures can be diagnosed based on history and physical examination alone. However, imaging studies such as ultrasound or MRI may be used in atypical cases or to assess the extent of injury, especially if urethral involvement is suspected 4 6 7.

Causes of Penile Fracture

Understanding how penile fractures occur can help in both prevention and recognition. The causes are often related to specific activities or accidents, but certain situations or behaviors increase the risk.

Cause	Scenario/Activity	Prevalence/Note	Source
Sexual intercourse	Blunt trauma during sex	Most common (48–88.5% cases)	2 5 6 7 8 9
Masturbation	Forceful bending or trauma	39% (in some studies)	2 5
Forced flexion	Intentional or accidental bending	Noted as significant cause	5
Rolling over/falling	Accidental trauma on erect penis	Less common	2
Sexual position	Doggy style, man-on-top, woman-on-top	Doggy/man-on-top higher risk	8 9
Injections	Rare complication of medical injection	Very rare	4

Table 3: Causes of Penile Fracture

Sexual Intercourse: The Leading Cause

• Blunt trauma during sex: The overwhelming majority of penile fractures occur during vigorous sexual activity, particularly when the erect penis accidentally strikes the partner's pelvic bone or perineum 2 5 6 7 8.
• Sexual positions: Research shows that 'doggy style' and 'man-on-top' are the positions most frequently associated with penile fracture, likely due to the angle and force involved. 'Woman-on-top' is less risky but still accounts for some cases 8 9.

Masturbation and Forced Flexion

• Self-inflicted injuries: Masturbation is the second most common cause, especially when excessive force or abnormal bending is involved 2 5.
• Forced flexion: Intentional or accidental forceful bending of the erect penis (sometimes in an attempt to suppress an erection) can also cause fracture 5.

Accidental Trauma

• Rolling over or falling: Less commonly, men may roll over or fall onto an erect penis during sleep or other activities, leading to injury 2.

Rare Causes

• Medical interventions: On rare occasions, penile fracture has been reported after medical procedures such as collagenase injections for Peyronie's disease 4.

Risk Factors to Consider

• Vigorous or uncoordinated sexual activity
• Alcohol or drug use (reduces awareness and control)
• Previous penile trauma or surgery

Understanding these causes can help men take precautions and avoid situations that might lead to this painful emergency.

Treatment of Penile Fracture

Prompt and appropriate treatment is essential for the best outcomes in penile fracture. Management strategies have evolved, with a strong consensus now favoring early surgical intervention.

Treatment	Approach/Steps	Outcomes/Complications	Source
Early surgery	Immediate surgical repair	Best outcomes, fewer complications	5 6 7 8 10 11
Conservative	Ice, compression, medication	Higher risk of ED, curvature, pain	5 10 11
Imaging	Ultrasound, MRI for diagnosis	Used in unclear cases	4 6 7
Urethral repair	Simultaneous repair if injured	Needed for urethral involvement	2 3 8 12
Follow-up	Monitoring erectile/voiding function	Long-term follow-up important	12

Table 4: Treatment Approaches

Early Surgical Repair: The Gold Standard

• Why surgery? Immediate surgical exploration and repair of the tunica albuginea results in the lowest rates of complications, including erectile dysfunction, penile curvature, and painful erections 5 6 7 8 10 11.
• Timing matters: Surgery performed within 24 hours is associated with the best outcomes, while delays increase the risk of permanent issues 4 5 6 7.
• Surgical technique: The incision is tailored to the injury's location (subcoronal or penoscrotal), and absorbable sutures are used for repair 4 6.

Conservative Management: When Is It Used?

• Who qualifies? Conservative (non-surgical) treatment—rest, ice packs, compression, pain medication—is rarely chosen today and may be considered only in uncomplicated, minor tears 10 11.
• Risks: Studies show significantly higher rates of erectile dysfunction, penile curvature, and painful erections with conservative management compared to surgery 5 10 11.

Imaging and Diagnosis

• Clinical diagnosis: Most cases are diagnosed based on history and examination 1 2 3 8 11.
• Imaging: Ultrasound or MRI may be used when the injury's extent or the presence of urethral involvement is unclear 4 6 7.

Management of Urethral Injury

• Assessment: Blood at the meatus or trouble urinating signals possible urethral injury. Cystoscopy or retrograde urethrogram may be used for diagnosis 2 3 8 12.
• Repair: Urethral injuries are repaired at the same time as the tunical tear 2 3 8 12.

Postoperative Care and Outcomes

• Follow-up: Long-term monitoring of erectile and urinary function is essential. Even with surgery, some patients may experience erectile dysfunction or voiding issues, but these are less common and often less severe than with conservative care 12.
• Complications: Possible complications include infection, penile curvature, erectile dysfunction, and, rarely, urethral fistula or persistent pain 5 7 8 12.

Conclusion

Penile fracture is a rare but serious urological emergency that requires prompt recognition and treatment. Although the topic may be sensitive, open discussion and awareness are crucial for optimal outcomes.

Key points covered:

• Symptoms: Sudden snap, pain, loss of erection, swelling, bruising, and deformity are classic; urethral bleeding suggests a more severe injury.
• Types: Most are unilateral tears of the tunica albuginea, but bilateral injuries and urethral involvement are more severe.
• Causes: Most commonly due to sexual intercourse (especially certain positions), but masturbation and accidental trauma can also be causes.
• Treatment: Early surgical repair is the gold standard, resulting in the best outcomes and fewest complications. Conservative management is only for select minor cases.

If you or someone you know experiences symptoms of penile fracture, seeking immediate medical attention is critical to ensure the best possible recovery.