A penile fracture is a tear in the tunica albuginea. The tunica albuginea is the rubbery sheath of tissue below the skin that allows the penis to increase in width and length to produce a firm erection. Sometimes the erectile tissue beneath the tunica albuginea also ruptures. That’s known as the corpus cavernosum.

Penile fracture is a medical emergency. If it happens, you need to get to a hospital as soon as possible, and you will probably need surgery. Quick treatment can help prevent permanent sexual and urinary problems.

If you take a sharp blow to the genitals, your penis may be sore or bruised. Penile fracture is a more severe injury. The following symptoms are red flags for possible fracture:

  • audible snapping or popping sound
  • sudden loss of your erection
  • severe pain following the injury
  • dark bruising above the injured area
  • bent penis
  • blood leaking from penis
  • difficult urination

Penile fracture happens when sudden trauma or bending of the penis breaks the tunica albuginea. The erectile tissue beneath the tunica albuginea may also rupture. These twin bodies of spongy tissue normally fill with blood when you are sexually aroused, producing an erection.

A fracture can also injure the urethra. The urethra is the channel in the penis that urine flows through.

Common causes of penile fracture include:

  • forceful bending of the penis during vaginal intercourse.
  • a sharp blow to the erect penis during a fall, car accident, or other mishap
  • traumatic masturbation

The most common cause of penile fracture in sexually active men is trauma during intercourse.

Although penis fracture can result from injury during any position in sexual intercourse, certain practices increase the odds. In heterosexual men, the woman-on-top position increases your risk. When the penis is momentarily blocked at the entrance to the vagina, the woman’s full weight can forcefully bend the erection. The woman may also rock too far forward or backward, bending the shaft of the penis. The rear-entry position is also associated with penile injuries.

Men in certain Middle Eastern cultures practice taqaandan, or penile cracking. This involves grasping the shaft of the erect penis and bending the top until you hear an audible clicking sound. Men do this for a variety of reasons, such as:

  • deflating an unwanted erection
  • attempting to enlarge or straighten their penis
  • out of habit, like cracking your knuckles

If you suspect a fracture, see a doctor as soon as possible. If not treated, a fracture can leave the penis permanently damaged. Fracture can also lead to difficulty having an erection. That’s known as erectile dysfunction (ED).

A doctor can confirm that you’ve fractured your penis based on an exam and discussion of the circumstances of the injury. You may need to have a medical imaging study done if your doctor cannot make a clear diagnosis through an exam. Imaging studies for penile injuries include:

  • a special X-ray, called cavernosography, which requires injecting a special dye into the blood vessels of the penis
  • a penile ultrasound, in which the internal structure of the penis is imaged with sound waves
  • magnetic resonance imaging (MRI) with a scanner that uses a magnetic field and radio-energy pulses to create detailed images of the inside of the penis

You may also need to undergo special urinary tests to check if the urethra has been damaged. This happens in up to 38 percent of men with have penile fractures.

A common test involves injecting a dye into the urethra through the tip of the penis and taking an X-ray. This reveals any damage or abnormalities the surgeon will need to know about when you undergo a repair.

Penile fractures usually require surgery. The surgeon will use stitches to close the tear in the tunica albuginea and corpus cavernosum. The main goals of treatment are to restore or maintain your ability to have erections and preserve urinary function.

After surgery, you’ll stay in the hospital, typically for one to three days. The doctor will prescribe pain medication and antibiotics. Take your medication as directed by your doctor.

After surgery, the fracture will take months to fully heal. You need to have follow-up exams and possibly imaging studies to:

  • check on the progress of healing
  • examine the veins and arteries in the penis
  • assess blood flow

You shouldn’t have intercourse for at least a month after surgery. Ask your doctor what you can do to assist in healing the injury.

Surgery has good results in over 90 percent of cases. Some men may experience side effects after the repair, including erectile dysfunction, curvature of the penis, and painful erections.

If you think you’ve fractured your penis, go to your local emergency services. Results are significantly better when treated within 24 hours of the injury. After surgery to repair the penis, most men regain the ability to have erections and report overall satisfaction with their sex life.

To avoid penile injuries, make sure there is adequate lubrication during intercourse and be careful during vigorous or “hard” penetrative intercourse. Also, avoid trying to force your erect penis into tight underwear or rolling over on an erection in bed. Any sudden force exerted on an erect penis could cause injury, major or minor.