Tag Archives: penile trauma

Broken Penis and Peyronie’s Disease

Posted on by Dr.Herazy

Penile fracture can lead to Peyronies

The most frequently found explanation of Peyronie’s disease usually refers to it as an exaggerated healing of penile trauma. This injury can be so small as to be unnoticed or so severe as to be considered a broken penis or a penile fracture.

A fractured penis is also known as a broken penis syndrome.  It is a severe and painful form of bending injury that occurs to the erect penis typically during intercourse when a thin tissue membrane of the penis called the tunica albuginea becomes ruptured or torn crosswise, not along the length of the penis.  When a penile fracture occurs it is often accompanied by a popping or cracking sound that can be heard by the sexual partner, and results in immediate flaccidity. Because of the severe pain in the penis, bruising, and swelling, this is considered a medical emergency that often results in surgical repair. When the fractured penis is severe, the urinary tube within the penis that drains urine from the bladder (urethra) can be damaged, leading to blood in the urine.

All couples who use the woman-on-top intercourse position have experienced times when the woman will thrust back and lift off  the penis only to come back down again, forcefully pushing and bending the penis against her pelvic bone , groin or vulva region.  And all men have had the experience of missing the point of penetration at the opening of the vagina during intercourse.  These two are the most common way to cause a penile fracture.

Approximately 1,000 cases of broken penises are reported each year in the U.S.  Men in their 20s and 30s are a higher risk because they are more inclined to engage in vigorous or acrobatic sexual activity that result in a broken penis.   Men in their 50s and 60s are less inclined not only because of reduced frequency and vigor of sexual activity, but because their erections tend to be less rigid.

It is not necessary to stop sexual activity if you have Peyronie’s disease, only that you become more careful and conservative about a few aspects of your sexual repertoire.  Especially for a man who already has a penile problem, it is most wise to avoid additional injury of another fractured penis so that the Peyronie’s sex problem is not made worse.   Peyronie’s Disease Institute suggests the following safety steps to avoid reinjury and possible worsening of an existing case of Peyronies:

  1. The man should not allow himself to be so filled with sexual excitement and abandon that the throws caution to the wind during intercourse.   He must be the calm and sensible one who monitors and evaluates the strength and control of thrusting and selection of sex positions so as to avoid those that put him at risk for additional injury.
  2. The man should be the one who does primary thrusting in intercourse  to reduce the chance of  additional penile trauma.
  3. Use of additional sexual lubrication during  sexual intercourse.  Even if his sexual partner produces adequate natural lubrication, apply additional sexual lubrication to avoid dryness during intercourse that can lead to additional injury while thrusting.

After the broken penis has healed begin a treatment plan using Alternative Medicine measures found on the PDI website.  

Possible Peyronie’s Cause: Catheter and Cystoscope Trauma

Posted on by Dr.Herazy

Unrelated cancer surgery possible cause of Peyronie’s disease

Debate and confusion persist about a Peyronie’s cause, no matter how much time passes.

We who deal with Peyronies on a daily basis know that not much research effort is given to this problem we share.  Medical research into the cause of Peyronie’s disease is often directed toward a genetic quirk or biochemical flaw within the cellular structure – that can be treated with drugs.  In spite of a hundred years of failure looking for a pharmacologically treatable Peyronie’s disease cause, one obvious area has not received much interest: trauma.

No one denies that trauma is at least a common secondary cause of Peyronie’s disease, if not the primary cause.  Yet, there is nothing in the medical literature that addresses the great amount of totally preventable trauma delivered while under medical care.  It is my opinion that doctors can be a Peyronie’s cause during the sometimes brutal and hidden trauma of male catheterization and cystoscopic examination that occurs before, during or after many types of surgery, like bladder or penis surgery.

Since 2002 when I started the Peyronie’s Disease Institute I have communicated with a host of surgical nurses.  They advise me that during surgery, while a man is under general anesthesia and is catheterized or given a urethral scope examination for any reason the process is often rushed and aggressive since the patient is not awake or aware.

To understand the potential problem, consider that the male urinary opening at the tip of the penis is a slit that averages 0.15 to 0.20 inches (4-5 mm) in length, compared to a 9 mm catheter or cystoscope that is put into that slit.  .

The potential for abuse that can lead to Peyronie’s disease exists because the size of the cystoscope used for men ranges from between the thickness of a pencil up to approximately 9mm.  In addition, many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.  That is a lot of material that goes up that little passage way.  Sometimes twists and narrowed areas of the male urethra are encountered that prevent passage, when the catheter or cystoscope will be forced deeper by a surgeon who encounters difficulty.  This, I have been told, is a common problem that is not much talked about.

Nurses get into big trouble, and jeopardize job security, for revealing what they see and hear in the operating room.

It is my speculation that unnecessary injury related to forceful and rushed catheterization or cystoscope insertion is the reason many men develop PD that they cannot otherwise explain.  This opinion is based on the number of men I speak to who tell me they cannot account for their PD based on penile trauma.  Of these men who recall no direct penile trauma, when I ask about any kind of surgery that took place within a year or so before developing PD, at least 95% tell me they were either catheterized or received a cystoscopic examination for one reason or another.

For this reason I speculate these men were traumatized during their catheterization or cystoscopic procedure sufficiently to injure their tunica albuginea enough to cause Peyronie’s disease.

One example within Peyronie’s disease research to support this theory of an association between surgical catheterization and cystoscopic examination and PD, comes from the Urology Service of the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, in June of 2010 published an article in Urology Times titled, “Peyronie’s Disease Following Radical Prostatectomy:  Incidence and Predictors.”

This search for a cause of Peyronie's disease must consider that for men in their 50s, both prostate cancer and Peyronie's disease are fairly common.  The purpose of this project was to determine if there was an actual link between those men who had a radical prostatectomy (RP) operation for prostate cancer and Peyronie’s disease.

They reviewed their sexual medicine database from 2002 to 2008.  They isolated men who received a RP as the only form of treatment for a well-defined and localized prostate cancer, looking for those who developed Peyronies within three years after their RP surgery and compared this group to those men who did not develop Peyronies.  They studied 1,011 such men, of whom 15.9% PD – a number higher than the general population.   They found that the average time for a man to develop PD after his RP was 14 months, give or take a month.   The average curvature was determined to be 31 degrees, +/- 17 degrees.   They further found that younger men (average of 59 years) who had a RP operation were more likely to develop PD afterward, than older men (average of 60 years), and that white race men (18%) were more likely to develop PD than non-white rave men (7%).    Also, they discovered that erectile function after RP surgery did not predict the later development of PD.

Because men who experienced sexual dysfunction after RP were found to develop Peyronie’s disease more frequently than the general population, the study suggested that this group should be routinely evaluated for PD.

This study, written by R. Tal, M. Heck and others, speculates that the Peyronie’s cause for these men might be somehow related to their prostate cancer.

Because it is common for the medical community to primarily delve deeply and intently into the biochemical and hereditary factors for a cause of Peyronie's disease,  without consideration of more simple and obvious reasons, they do not much evaluate for trauma.   Surgical trauma is a possible Peyronie’s disease cause for those with a history of prior radical prostatectomy (because of the cystoscopic and catheterization procedures they receive), but apparently is not investigated since this would cause a medicolegal problem for the medical community and little reason to use medication.