A 36-year-old man learned the hard way that surgical intervention was needed when he fractured his penis having acquired what is known as an eggplant deformity - named for the appearance of the bruising pattern that develops. Though such an injury is thankfully uncommon, it can be sustained during robust and spirited sex or alternate trauma. This particular account of penile damage endured after protracted erection resulting from sildenafil (aka Viagra) use was just published in the British Medical Journal (BMJ).
What happened to him?
Apparently, the man took a standard dose of the medicine which is a phosphodiesterase type 5 (PDE-5) inhibitor. Once stimulated sexually, the drug facilitates increased blood flow to the penis so it becomes engorged to maintain an erection. It acts against an enzyme thereby allowing for the blood delivered to the penis to remain there longer (since the effect is on regulating penile blood flow this also impacts its removal). Noting that his erection persisted beyond his sexual encounter, he attempted “vigorous masturbation” to remedy the situation but to no avail. He proceeded to fall asleep which was when his child came in and accidentally fell over the erect phallus. In this instant, the patient felt “sudden severe pain in his penis and lost tumescence.”
In many such scenarios, due to shame or lack of understanding the severity of the problem, people tend to delay seeking medical care. This can only exacerbate things. Ultimately, in this case, the man sought treatment after two days “with complaints of swelling, pain and deformed penis.” After confirmatory testing, he was operated on for repair of a corporal tear and evacuation of a large overlying hematoma, or blood collection usually entering tissue or space surrounding an injured blood vessel. Fortunately, there were no long term consequences and the patient resumed normal function without lasting issue or disfigurement.
The gist of this type of injury
According to Cedars-Sinai Medical Center attending urologist Susan Rusnack, M.D.,
“He is lucky. The longer the delay, the less likely for a successful repair. If you wait long enough, then generally it won’t even get repaired. It is already forming scar tissue and can’t be repaired - so patients can end up needing erectile drugs or later surgery for implantable devices. This is one of the few actual urological emergencies. If you have vigorous sex, hear a tearing nose, feel a pop and feel pain and lose the erection, then that is the more classic story. If you have an erection and you bend the penis, then you are going to fracture it. You can’t fracture your penis without an erection - and that isn’t necessarily with use of erectile dysfunction medications. Embarrassment and lack of knowledge that you did serious damage is what causes the greatest issue and delay in care.”
Dr. Rusnack cautions that “if it doesn’t get repaired, you will have an impact later in life especially if young and in a certain number of cases there can be tearing of the urethra” which creates a host of other challenges (to learn more about such penile and urethral injury, review here).
In this case, the use of Viagra certainly contributed to the man’s priapism, or prolonged erection beyond sexual arousal, so he likely would have needed medical evaluation anyway. The fracturing of his penis though could occur when someone is on or off any of these drugs. Abuse of these medicines is also common and Dr. Rusnack warns
“people don’t realize there are consequences to taking things they don’t need and though this can happen with any of the medications” she sees “priapism much more often from use of herbal supplements, particularly those containing yohimbine, than” she does “from the various prescription medications.”
This is not surprising given such supplements are not as regulated, so they can have disparate levels of such a chemical without being subjected to the same quality control, safety or efficacy measures as prescription medications.
Fracturing your penis is a medical emergency and should be addressed expeditiously. Delays can cause meaningful harm. Non-missionary sexual positions are at greater risk of causing this eventuality. The force it takes to buckle a penis has to be strong and just off the straight down of the long axis. Aggressive thrusting during intercourse can prompt hitting the pelvis or misalignment upon re-entry, for example, causing the penis to bend. To learn more about injury prevention, read Stuff Not To Do With Your Penis.