First, let’s have a quick anatomy lesson. The penis can be divided into specific compartments. The paired corpora cavernosa are the chambers that fill with blood during an erection. The glans penis (head of the penis) is an expansion of the corpus spongiosum. The urethra travels through the corpus spongiosum and is responsible for draining urine from the bladder. There is a very strong layer that covers the corpora cavernosa (the chambers that fill with blood during an erection) this is called the tunica albuginea. A lot of nerves, arteries and veins run through the penis as it is a very sensitive and vascular organ.
It may seem weird but your penis is just like any other organ that requires proper maintenance and upkeep. Below are a few topics relating to penile health, including circumcision, injuries and curvature (Peyronie’s disease) and how to manage them.
Adult Circumcision – Circumcision dates back more than 6,000 years with different religions, countries and cultures having adopted a variety of views on the subject. The origin of circumcision ranges from religious sacrifice, rite of passage, an aid to hygiene and even a method to discourage masturbation.1 That being said, circumcision tends to happen when the baby is young and therefore does not remember having had the procedure. However, there are instances when an adult requires circumcision, such as when they are unable to retract the foreskin to allow exposure of the glans penis (head of the penis). This is called phimosis. Alternatively, people sometimes require urgent circumcision when the foreskin is pulled back and unable to go back over the glans. Called paraphimosis, this can be very painful and is a medical emergency.2
Adult Phimosis – The inability to retract the foreskin is most commonly caused by a skin condition called Lichen sclerosus et atrophicus or Balanitis xerotica obliterans (BXO).3 Other symptoms that can occur are local infection, irritation, discomfort after peeing, bleeding, painful intercourse and even at times the inability to pee altogether. This, of course, is a medical emergency. The cause of the condition is unknown. Treatment includes medical and surgical management. There is limited benefit to treating mild cases of BXO that have mild scarring with steroid ointments. Circumcision is the preferred treatment option for this condition, along with opening of the end of the urethra, as BXO can often cause it to narrow, making peeing difficult.
Penile Fracture – Luckily, injuries to the penis are very uncommon given its mobility. As one would expect, the most common cause of fracture occurs during vigorous sexual intercourse, when the rigid penis slips out of your partner and strikes the perineum, pubic bone or leg, causing a buckling injury. Other less common causes include masturbation and rolling over or falling onto the erect penis.4 What happens during a penile fracture is a tear in the tunica albuginea, which is the strong fibrous layer of connective tissue surrounding the corpora cavernosa of the penis. These chambers fill with blood during an erection, giving the penis rigidity for intercourse.
- Presentation and Symptoms – The most common presentation includes hearing a cracking or popping sounds as the tissue tears, followed by pain, rapid loss of erection, and discoloration and swelling of the penile shaft. Some patients also present with an “egg plant” deformity caused by the significant bruising. At times the urethra itself can be involved and patients complain of peeing blood.5
- Management – Because of the sensitive nature of the topic, presentation to the emergency department or clinic is sometimes delayed. The standard treatment is surgical correction as this leads to faster recovery, lower complications and a lower rate of long-term penile curvature. Therefore, it is important for people who are concerned that they may have fractured their penis to go immediately to the emergency department for evaluation.6
Penile Curvature – Penile curvature, or Peyronie’s disease, is recognized as a wound-healing disorder of the tunica albuginea, the touch connective tissue surrounding the cylindrical bodies that engorge with blood during erections. This process results in a scar formation that can occur after an injury to the penis, which activates the abnormal wound-healing process.7When the penis is in its erect state, the pressure inside the penis can become quite high. Higher external pressure may result in a microfracture. A common misconception is that the trauma to the penis must occur when it is erect, however, trauma to the soft penis may also trigger this process. One of the most important characteristics of this particular wound-healing disorder is that once the scar has occurred, it does not undergo normal remodelling and therefore the deformity won’t go away.8
- Presentation – Patients often present with penile pain, erect deformity, feeling a lump on their penis as well as erectile dysfunction. Once the penis stops curving, most pain will resolve.
- Management – Some patients require only reassurance, especially if there is no difficulty or pain for the patient or his partner in accomplishing intercourse. Patients should also be reassured that this will not turn into cancer and is not life-threatening.
- Nonsurgical and surgical treatments – Please refer to our Peyronie’s article to learn more about the nonsurgical and surgical treatment options available.
1. Palmer, JS. An international view on circumcision. Dial Ped Urol. 2009;30:1-8.
2. McCammon, KA et al. 2016. Surgery of the Penis and Urethra, Campbell-Walsh Urology; Eleventh Edition. Philadelphia, PA: ELSEVIER.
3. Akpoeaye LE, et al. Balanitis xerotica obliterans (BXO). AUA Update Series. 1997;16:166-167.
4. Al Ansari A, et al. Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review. Int J Impot Res. 2013;25:221-223.
5. Morey AF, et al. 2016. Genital and Lower Urinary Tract Trauma, Campbell-Walsh Urology; Eleventh Edition. Philadelphia, PA: ELSEVIER.
6. Mazaris EM, et al. Penile fractures: immediate surgical approach with a midline ventral incision. BJU Int. 2009;104:520-523.
7. Levine, LA et al. Standard operating procedure for Peyronie’s disease. J Sex Med. 2013;10:230-244.
8. Levine LL, et al. 2016. Diagnosis and Management of Peyronie Disease, Campbell-Walsh Urology; Eleventh Edition. Philadelphia, PA: ELSEVIER.