TRAUMA (PENIS):

TRAUMA (PENIS):

Dear Sumner:

This letter follows my call to you re John, who is a very embarrassed and frightened 24 year old man who was having a rather vigorous sexual experience with his girlfriend (she was in the dominant position), when heard an actual snapping sound and felt a sharp pain in his penis. He has been unable to urinate since then. As you have probably observed yourself by this time, his penis is very tender, swollen and discolored. He is sure that this is the end of his sex life! How can you find out what is going on here and, more importantly, what can you do to “make it all better?” Both John and his girlfriend would be extremely grateful for your help.

Dear Elsie:

This was surely one very distressed young man. My diagnosis was that of a penile fracture…i.e. disruption of one or both of the compartments which fill with blood during erection (the corpora cavernosa). Generally, imaging studies are not necessary since, in such cases, you can usually feel a distinct firm mass on the penis, which represents the hematoma at the site of disruption. However, it is important to be certain there is no associated injury of the urethra. Especially since John was unable to urinate since his injury, I obtained a urethrogram. His channel appeared intact.

Penile fracture is obviously not a very common occurrence and some physicians treat this problem conservatively, hoping for spontaneous healing to take place. However, because of the high incidence of complications with that approach, such as penile curvature and erectile dysfunction, early surgical intervention may be preferable. Accordingly, after a rather detailed discussion with John and his girlfriend weighing the pros and cons of surgery, we did proceed with the repair. The surgery went smoothly and I am optimistic that John and his girlfriend will have a happy future together (though perhaps a bit less vigorous than in the past).