Fast Five Quiz: Painful Sexual Intercourse

Bradley Schwartz, DO; Michel E. Rivlin, MD


May 21, 2021

The frequency of penile fracture is probably underreported in the published literature. Trauma during sexual relations is responsible for approximately one third of all cases; the female-dominant position is most commonly reported. Most affected patients report penile injury coincident with sexual intercourse. Patients usually report that the female partner was on top, straddling the penis, and that the penis slipped out, hitting the perineum or the pubis of the female partner. The mechanism of action may lead to embarrassment, causing patients to avoid seeking treatment and contributing to late presentation.

Patients with penile fracture typically describe a popping, cracking, or snapping sound with immediate detumescence. Less severe penile injuries can be distinguished from penile fracture, as they are not usually associated with detumescence. These patients may report minimal to severe sharp pain depending on the severity of injury.

Upon inspection, significant soft tissue swelling of the penile skin, penile ecchymosis, and hematoma formation are apparent. 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.

Patients with concomitant urethral trauma report hematuria upon postinjury voiding. Around a third of men with penile fractures demonstrate blood at the meatus. Some patients may also report dysuria or experience acute urinary retention. Retention may be secondary to urethral injury or periurethral hematoma that is causing a bladder outlet obstruction.

Read more about penile fracture.