Written by Sylvester Ikhisemojie - Nigeria
Although this is an exclusively male disease or catastrophe, some of the emotional difficulties caused by its occurrence are suffered by the woman, not least because she would blame herself for helping to bring the injury about and also because women are responsible for most of the cases that happen. It is, therefore, a problem that ought to be of interest to both sexes. This is a painful condition that occurs when there is an injury to an erect penis.
During this unique period, the erect penis becomes the way it is as a result of blood rushing into the shaft thus causing an engorgement. This is made possible because the penis is essentially made of two cylinders. Each one is known as the corpus cavernosum. Blood retained in those cylinders is responsible for the erections men experience. During a sexual encounter, if the act is unduly vigorous or the position is abnormal, the covering sheath called the tunica albuginea, of one or both of those cylinders can rupture and cause an audible cracking sound very similar to the one you may hear when a bone breaks. It is described as a loud "pop."
This injury most frequently happens accidentally during intercourse. It may also happen in the course of vigorous masturbation. Sometimes, it occurs in forceful and rapid vaginal penetration or when a couple have kinky sex or when the female sits astride her man facing away from him. As a result, the kind of injury described above can result. Another scenario for such an occurrence is when a woman with an ample frame sits atop an erect penis and rides it with a significant degree of vigour. Some of the signs are a cracking sound; a sudden loss of the erection; severe pain in the penis and the appearance of what would look like a purple bruise on the organ which would appear because some of the blood previously in the cylinder is now escaping into the penis itself.
Sometimes, the tube which drains the urine from the bladder, called the urethra, may also be damaged as a result and blood may then be visible at the urethral opening.
The "woman on top position" has been implicated in most of the cases of penile fracture and it is speculated to result from the fact that when she is so positioned, she has no choice but to place her weight on the erect penis. Since she is in control of this particular movement, interrupting it in the course of passion is not likely and as a result this injury is almost certain to happen. On the other hand, a couple in the missionary position places the control of nearly all the action in the man's hands and this kind of injury is thus less likely to happen in that position because the man would interrupt all activity at the first hint of pain. In the other position, he is at the mercy of the woman who would not stop her activity until he cries out in pain. By then, the penis has been fractured.
This injury demands immediate medical attention. It is a genuine emergency. It is painful and the penis is deformed. There is the urgent need for a surgeon to attend to the victim and preferably a urologist if one is available. The immediate needs are to re-establish the continuity of the urethra by passing a catheter into the bladder so that urine can be drained and passed without hindrance. Then the patient should be taken to an operating room where the painstaking repair must be done if the penis is to function normally again. Time is of the essence and much is to be gained when little or no time is lost between the time that the injury occurs and when the patient gets to the appropriate experts.
Delay in getting the required surgical repair increases the likelihood of suffering complications. Other associated injuries that may result include some damage to the nerves and certain blood vessels at the upper aspect of the penis called the dorsum, close to the base of the shaft. Some of these complications are:
1) Erectile dysfunction,
2) A bent penis which may become permanent,
3) Painful erections subsequently,
4) Injury to the urethra that may even lead to the formation of a stricture,
5) Painful sexual intercourse,
6) Haematoma which is the localised collection of blood,
7) Penile abscess formation resulting from infections.
This is by no means a common problem that will present in the emergency room but the incidence is rising.
Following the operation, the patient is usually followed up for some period before he can be given the all-clear. The catheter may be left in place for up to two weeks at the first instance and may be left for another fortnight if any problem has been observed especially a residual leakage of urine or blood from the site of repair. This is dependent on the time frame from the time of injury to the time when repair is carried out. If one happens to sustain this kind of injury, one should not waste time looking for any alternative treatment. Just go to a hospital where you can avail yourself of proper and timely treatment that is not based on guesswork.
Minimum investigations are also necessary because the diagnosis is pretty obvious.