Penile Fracture

Penile fracture

Penile fracture is the traumatic rupture of the tunica albuginea of one or both corpora cavernosa, classically occurring when an erect penis is forcibly bent. It is a urological emergency: prompt recognition, appropriate imaging, and early urology involvement reduce long‑term sexual and functional morbidity.

Anatomy and pathophysiology

• The corpora cavernosa are enveloped by the tunica albuginea, which becomes thinned and more vulnerable during erection.
• Sudden blunt force or abrupt lateral bending can tear the tunica albuginea, allowing blood to extravasate into subcutaneous tissues and form a haematoma.
• The corpus spongiosum and urethra lie ventrally; severe or ventrally directed tears may involve the urethra and cause urethral injury.

Typical mechanism

• Most commonly occurs during sexual intercourse (misdirected thrust) with an audible “pop” or crack and immediate loss of erection.
• Other causes include masturbation, rolling onto an erect penis, blunt trauma, or assault.
• If assault or sexual violence is suspected, follow local forensic and RCEM sexual‑assault guidance and involve appropriate services.

Clinical features

• History: sudden audible pop, immediate or rapid detumescence, and sharp pain at the time of injury.
• Examination: penile swelling and bruising that may extend to the scrotum, perineum, and lower abdomen.
• Examination: palpable defect or “step” in the shaft and severe focal tenderness.