Fast Five Quiz: Sexual Intercourse Injuries

Richard H. Sinert, DO


June 10, 2022

The clinical presentation of a penile fracture is often fairly straightforward. Diagnosis is based on history and physical examination findings. The fractured penis is often quite tender to the touch. Because of the severity of pain, a comprehensive penile examination may not be possible.

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.

Patients often describe a popping, cracking, or snapping sound with immediate detumescence. Less severe penile injuries can be distinguished from penile fracture because they are not usually associated with detumescence. Successful voiding does not exclude urethral injury; therefore, retrograde urethrography is required whenever urethral injury is suspected.

Patients with a rupture of the deep dorsal vein of the penis can present with findings similar to those of a penile fracture. Associated swelling and ecchymosis of the penis ("eggplant" sign) is present. Injury commonly occurs during sexual intercourse. However, the patient does not typically hear a crack or popping sound. In addition, detumescence does not immediately occur. However, because of similar physical examination findings, a deep dorsal vein rupture should be surgical explored because it is often difficult to differentiate from penile fracture.

Learn more about the presentation of penile fracture.