A penile injury is a

medical emergency A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...

that afflicts the

penis A penis (; : penises or penes) is a sex organ through which male and hermaphrodite animals expel semen during copulation (zoology), copulation, and through which male placental mammals and marsupials also Urination, urinate. The term ''pen ...

. Common injuries include

fracture Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...

avulsion injury In medicine, an avulsion is an injury in which a body structure is torn off by either trauma or surgery (from the Latin ''avellere'', meaning "to tear off"). The term most commonly refers to a surface trauma where all layers of the skin have bee ...

, strangulation, entrapment, and

amputation Amputation is the removal of a Limb (anatomy), limb or other body part by Physical trauma, trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as cancer, malign ...

Epidemiology

Penetrating and blunt traumas combined make up approximately 90% of all civilian penile injuries (45% each), with burns and other accidents making up the remaining 10%.

Types

Fracture

Penile fractures are the result of rupture of the tunica albuginea. They are fairly rare and can co-occur with partial or complete

urethral rupture Rupture of the urethra is an uncommon result of penile injury, incorrect catheter insertion, straddle injury, or pelvic girdle fracture. The urethra, the muscular tube that allows for urination, may be damaged by trauma. When urethral rupture occ ...

, though this is rare. Urethral damage occurs in 10–38% of cases. Fractures are treated with emergency surgery, and can be diagnosed with

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

, especially in pediatric cases. Penile fractures are caused by trauma to the erect penis, typically by suddenly bending it laterally during penetrative intercourse with the receptive partner on top of the penetrating partner, or during

masturbation Masturbation is a form of autoeroticism in which a person Sexual stimulation, sexually stimulates their own Sex organ, genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. Stimulation may involve the use of han ...

. Characterized by a loud popping sound at the time of the injury, the result of the tunica albuginea rupturing. Other symptoms include severe pain, loss of erection, and swelling. Symptoms of urethral injury include hematuria, blood at the meatus, and dysuria. If left untreated, complications result in 28–53% of cases; these include permanent curvature of the penis,

fistula In anatomy, a fistula (: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other h ...

urethral diverticulum A urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers (fascia) that surround it. Signs and symptoms Urethral diverticula are often asymptomatic and symptoms that are present te ...

priapism Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases ...

, and

erectile dysfunction Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a Human penis, penile erection with sufficient rigidity and durat ...

Degloving and avulsion

Degloving and avulsion injuries involve the removal of the penis skin, which is a serious medical emergency. Treatment of these injuries involves either closure of the torn skin, or a skin graft to replace the skin lost in the injury. Skin grafts are constructed to attempt to preserve erectile function and sensation.

Soft-tissue injuries

Strangulation

Strangulation injuries to the penis, also called incarceration injuries, are caused by hair, rubber bands, or other objects. Hair strangulation may be hard to diagnose due to the anatomy of the penis; the hair causing the strangulation may be hidden under the coronal sulcus if it is swollen. In adults, strangulation injuries that require medical treatment can be caused by a variety of objects typically used for the purpose of sexual gratification, extending the time of an erection, or

enuresis Enuresis is a repeated inability to control urination. Use of the term is usually limited to describing people age-appropriateness, old enough to be expected to exercise such control. Involuntary urination is also known as urinary incontinence. Th ...

, including metal rings, which must be removed by specialized cutting instruments. The object can also be removed by decompressing the penis. Because the vasculature of the penis is compressed, a variety of complications can result from strangulation injuries, depending on whether the veins, arteries, or both are compressed, including mild, reversible vascular obstruction; ischemic necrosis;

gangrene Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...

and

kidney damage Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can b ...

;

lymphedema Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized edema, swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns inters ...

; ulceration; urethrocutaneous fistula, loss of sensation; urethral injury;

sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...

; and

autoamputation Autoamputation is the spontaneous detachment (amputation) of an appendage or organ from the body. This is not to be confused with self-amputation. It is usually due to destruction of the blood vessels feeding an extremity such as the finger tips. ...

. Penile strangulation injuries that require medical attention are rare: since their first description in 1755, there have been approximately 60–120 reported cases. Though usually acute, cases of chronic strangulation and acute cases lasting up to one month have been reported. Various objects have been involved in cases of strangulation: *

Wedding ring A wedding ring or wedding band is a finger ring that indicates that its wearer is married. It is usually forged from metal, traditionally gold or another precious metal. Rings were used in ancient Rome during marriage. In western culture, a ...

* Steel ring * Bottle *

Chastity belt A chastity belt is a locking item of clothing designed to prevent sexual intercourse or masturbation. Such belts were historically designed for women, ostensibly for the purpose of chastity, as an anti-rape device, or to dissuade women and thei ...

Entrapment

The most common soft-tissue injury is an entrapment injury involving the skin of the penis caught in a zipper; these injuries are particularly common in young children who are uncircumcised and are always superficial. They are treated by removing the zipper with

local anesthesia Local anesthesia is any technique to induce the absence of sense, sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. ...

using a bone cutter, lubrication, or hacksaw, dismantling the zipper, or removing the affected tissue, and can be prevented in most situations by

circumcision Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. T ...

, since the

foreskin In male Human body, human anatomy, the foreskin, also known as the prepuce (), is the double-layered fold of Human skin, skin, Mucous membrane, mucosal and Muscle tissue, muscular tissue at the distal end of the human penis that covers the glans ...

is the most commonly affected tissue. If not treated promptly, the affected tissue can swell and become infected. In some cases, emergency circumcision is necessary.

Other

Other soft-tissue injuries to the penis can be caused by burns,

animal bite An animal bite is a wound, usually a puncture or laceration, caused by the teeth. An animal bite usually results in a break in the skin but also includes contusions from the excessive pressure on body tissue from the bite. The contusions can occu ...

s, and human bites. Animal bites are common in children, and dogs are the most common animals involved. Though typically not severe, animal bites can cause amputation or infection. Treatment for animal bites and human bites involves antibiotic treatment and closure of the wounds by secondary intention because they are contaminated. Penis burns can be very severe and often require specialized care in a burn unit to prevent

contracture In pathology, a contracture is a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement. A contracture is usually permanent, but less commonly can be temp ...

s, severe scarring, or other complications including lymphedema, hypospadias, or necrosis. This treatment can involve debridement, skin grafts, antibiotics, and the use of a suprapubic catheter. Because of its thin skin, the penis is susceptible to full-thickness, third-degree burns. Burns to the penis typically co-occur with other severe burns. Most thermal penis burns are first or second degree burns caused by flame; some are caused by grease or boiling water. Electrical burns are typically deeper than thermal burns and require more extensive tissue removal.

Amputation

Amputation of the penis can be either partial or complete. Often self-inflicted by people with

psychiatric disorders A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

, it may be occur with other trauma, such as in an assault or a mechanical accident. These injuries are treated by re-implantation if possible, with or without

anastomosis An anastomosis (, : anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal (su ...

of the vasculature to restore erectile function;

skin necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who is o ...

and loss of sensation are common complications after treatment.

Microsurgery Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) whi ...

on the vasculature decreases the risk of necrosis significantly. Klingsor syndrome is a psychiatric disorder that causes self-harm, which can involve the penis.

Paranoid schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, hearing voices), delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin ...

eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's health, physical or mental health, mental health. These behaviors may include eating too much food or too little food. Types of eatin ...

s, and

psychotic break In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or incoher ...

s can also be associated with penile injury. In some cases,

transgender A transgender (often shortened to trans) person has a gender identity different from that typically associated with the sex they were sex assignment, assigned at birth. The opposite of ''transgender'' is ''cisgender'', which describes perso ...

people who are not able to access genital surgery may self-amputate their penis. Favorable prognostic factors for replantation of amputated penises include short ischemic time and a clean incision (as opposed to a crush injury or ragged incision). Replantation of an amputated penis can be done up to 24 hours after the injury, though fewer than 16 hours of cold ischemia or 6 hours of warm ischemia leads to the best outcomes. If replantation is not possible or desired, a penile stump can be closed and

phalloplasty Phalloplasty (also called penoplasty) is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement. History Russian surgeon Nikolaj B ...

could be performed later.

Penetration

Penetrating injuries can be caused by accidents during sexual activities (typically, by foreign objects inserted into the urethra), by weapons (i.e. bullets) during wartime, or by stabbing. These injuries can have varying severity and be superficial, affect the corpora cavernosa, other soft tissue, and/or urethra. In 50% of cases, the urethra is injured. Some foreign objects may be removed like any other penetrating object in soft tissue; using forceps and gentle traction. However, if the foreign object was inserted into the urethra or has damaged the urethra transversely, urethography is used to avoid further injury to the urinary tract while removing the object. Penetrating injuries make up approximately 45% of civilian penile injuries.

Classification

Causes

The causes of penile injury are mostly the same as other causes of trauma; however, penile injury is more likely to occur during sexual intercourse and masturbation than other traumas. Nocturnal erections and sleeping positions can be another cause of penile injury. Industrial and automobile accidents can also cause penile injury.

Self-injury Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, usually without suicidal intention. Other terms such as cutting, self-abuse, self-injury, and s ...

may also affect the penis. $Penile fracture$

Diagnosis

Most penile trauma can be diagnosed by history and physical examination, hearing 'snapping' or 'popping' sound, immediate penile pain, swollen, bruised (often known as eggplant deformity), some may notice blood over the urethral meatus. But in some cases, ultrasonography can indicate the extent of the injury and help a clinician decide if the injured person needs surgical treatment. It is important to rule out urethral injury in those with penile injury, as it is a urological emergency that may result in significant morbidity if left untreated.

Treatment

The type of injury dictates the treatment; however, surgery is a common treatment. Most traumatic penile injury warrant an emergency repairing surgery to prevent complications and maintain functionality of the penis sexually and urologically. Catheterization is usually a part of treatment for penis injuries; when the urethra is intact, urethral catheterization may be used, but if it has been injured, suprapubic catheterization is used. Some injuries, including animal bites, are also treated with

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

irrigation Irrigation (also referred to as watering of plants) is the practice of applying controlled amounts of water to land to help grow crops, landscape plants, and lawns. Irrigation has been a key aspect of agriculture for over 5,000 years and has bee ...

, and rabies prophylaxis.

Complications

Common complications from penile injury are erectile dysfunction, abnormal penile curvature, penile abscess, formation of fibrotic plaques, painful erection, urethral stricture, uretherocutaneous or corporourethral fistula.{{Cite web, date=2019-11-09, title=Penile Fracture and Trauma: Practice Essentials, Background, Relevant Anatomy, url=https://emedicine.medscape.com/article/456305-overview, url-access=registration, access-date=2024-05-03, archive-date=2024-02-11, archive-url=https://web.archive.org/web/20240211213523/https://emedicine.medscape.com/article/456305-overview, url-status=live

References

injury Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...