The Penis
is an external sexual organ of male humans.
In the Shaft of the Penis it has Two Corpus Cavernosum, A pair of sponge-like regions of erectile tissue which contain most of the blood in the penis during erection. The Tunica albuginea which is fibrous that envelope of the corpora cavernosa penis. involved in maintaining an erection, it constricts the deep dorsal vein of the penis, preventing blood from leaving and thus sustaining the erect state. The Lacunar space (Space of Smith) which Surrounds tunica albuginea and is an Intralacunar smooth muscle. The Corpus spongiosum which is the smaller of the three bodies composing the penis. It is composed of a loose erectile tissue, similar in appearance to that of the corpora cavernosa, but of much finer texture. It does not contribute to penile rigidity and it contains urethra.
Glans Penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female. When the penis is flaccid it is sometimes wholly or partially covered by the foreskin, except in men who have been fully circumcised.
Penile Fracture:
Penile fracture is the traumatic rupture of the Corpus cavernosum or the body of the Penis, caused by the rupture of the Tunica albugenea. It is most often caused by a blunt trauma to an erect penis. Traumatic rupture of the penis is relatively uncommon and is considered a urologic emergency.
Causes:
The practice of taqaandan (also taghaandan) also puts men at risk of penile fracture. Taqaandan, which comes from a Kurdish word meaning "to click," involves bending the top part of the erect penis while holding the lower part of the shaft in place, until a click is heard and felt. Taqaandan is said to be painless and has been compared to cracking one's knuckles, but the practice of taqaandan has led to an increase in the prevalence of penile fractures in western Iran. Taqaandan may be performed to achieve detumescence
Usually occurs during sexual intercourse "Woman-on-top" when the penis slips out of the vagina and strikes the perineum or the pubic symphysis. Other causes include Inappropriate masturbation method or too much masturbation, gunshot wounds, Intentional or unintentional forcible breaking of an erect penis, a
dditional rare etiologies include turning over in bed, a direct blow, or hastily removing or applying clothing when the penis is erect.
Diagnosis is made based on history and physical examination findings. Most affected patients report penile injury coincident with sexual intercourse. Patients usually report that the female partner was on top, straddling the penis. During sexual relations, the penis slipped out, hitting the perineum or the pubis of the female partner. Patients sometimes report that they were having sexual relations on a desk (Female Partner on Top of the Desk) and the penis slipped out, hitting the edge of the desk.
Patients describe a popping, cracking, or snapping sound with immediate detumescence. They may report minimal to severe sharp pain, depending on the severity of injury.
Upon physical examination, evidence of penile injury is self-evident. In a typical penile fracture, the appearance is completely obliterated because of significant penile deformity, swelling, and ecchymosis (the so-called "eggplant" deformity).
The penis is abnormally curved, often in an "S" shape. The penis is often deviated away from the site of the tear secondary to mass effect of the hematoma. If the urethra has also been damaged, blood is present at the meatus.
If the Buck fascia is intact, penile ecchymosis is confined to the penile shaft. If the Buck fascia has been violated, the swelling and ecchymosis are contained within the Colles fascia. In this instance, a "butterfly-pattern" ecchymosis may be observed over the perineum, scrotum, and lower abdominal wall.
A rolling sign may also be present, it is the palpation of the localized blood clot over the site of rupture. The clot may be felt as a discreet firm mass over which the penile skin may be rolled.
Treatment:
Penile fracture is a medical emergency, and emergency surgical repair is the usual treatment. Delay in seeking treatment increases the complication rate. Non-surgical approaches result in 10%-50% complication rates including erectile dysfunction, permanent penile curvature, damage to the urethra and pain during sexual intercourse.
In some cases, retrograde
urethrogram may be performed to rule out concurrent urethral injury.
Legal Issue:
For legal context, see Doe v. Moe, 63 Mass. App. Ct. 516, 827 N.E.2d 240 (2005), where the court declined to find duty as between two consensual adults. The plaintiff in this case, a man who suffered a fractured penis, complained that the defendant, his ex-girlfriend, had caused his injury while she was on top of him during sexual intercourse. The court ruled in her favor, determining that her conduct was neither legally wanton nor reckless.
Reference:
1.
8.Fundamentals of Anatomy & Physiology 2nd Edition byDonald C. Rizzo
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