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Wednesday, June 19, 2013
The two main functions of the penis are urinary and reproductive. Inside the penis there are three tubes that are wrapped together by a very tough fibrous sheath. One is called the urethra. It is hollow and allows urine to flow from the bladder through the hole in the prostate, through the penis and to the outside. The two other tubes are called the corpora cavernosa. The corpora cavernosa are spongy tubes that are soft until filled with blood during an erection.
At the time of sexual activity, the erection of the penis allows it to be inserted. In this situation, the urethra acts as a channel for semen to be ejaculated. The penis facilitates conception and pregnancy, and also serves as a source of sexual pleasure for the man and his partner.
Painful erections are very uncommon unless you have recently experienced penile trauma or irritation. Other causes of erectile pain would include:
Peyronie's disease is characterized by a plaque or lump that forms on the penis. This plaque can result in pain or cause the penis to bend during an erection. Treatment can involve oral pills, topical cream, injection of certain medications into the plaque, radiation therapy, or surgery.
With any penile mass, you should have it examined to make sure that it is not anything to worry about (i.e. cancer). An ultrasound and/or biopsy can be considered for further evaluation. Follow-up with your personal physician is essential.
Priapism is a prolonged painful erection, lasting more than four hours, that does not result from sexual desire and does not subside despite orgasm. Normally, blood enters the erectile tissues of the penis and forms an erection which subsides with an orgasm.
Priapism lets the blood into the penis, but will not let it out with an orgasm. It is either due to too much blood flowing into the erectile tissues of the penis (high flow state pripaism), or from blood not leaving the corpora fast enough (low flow state priapism). High flow state is usually associated with trauma. Low flow state is more common and is associated with sickle cell disease, and possibly the side effect of various medications. Prolonged erections may cause scarring of the erectile tissues (the corporeal tissues) and may result in the inability to achieve an erection with repeat bouts of priapism over time.
Long-lasting (greater than 4 hours), ischemic erections, known as low flow priapism, usually consist of a painful erection, due to the lack of oxygen to the penis. This problem is a medical emergency condition and should be treated within a short period of time. The treatment of priapism is to remove blood from the corporeal bodies. Sometimes medication in the form of an injection can be used to achieve this and sometimes surgical intervention is required.
The condition known as high flow priapism is characterized by a constant, painless erection. This is not a medical emergency, but requires medical attention nonetheless.
Phimosis is tightness of the prepuce (foreskin) of the penis that prevents the retraction of the foreskin over the glans. The condition is usually congenital, but it may be the result of an infection, commonly linked to neglected hygiene.
Germs breed under the foreskin with its enclosed glans. The delicate tissues undergo a process of partial healing, partial flare-up, and partial healing again. Scar tissue keeps building up and breaking down. Eventually, the scar tissue becomes fibrous, hard, tough and inelastic. It contracts the meatus, pulling the infected foreskin tightly inwards. At the same time, nearby healthy tissue strives to form new scabs and becomes infected. This adds to the spread of germs.
If untreated, the infection spreads and the foreskin swells up. Eventually, the foreskin becomes so large that it cannot retract. It is swollen and tight, and cannot be moved back away from the glans.
Symptoms of phimosis include:
- The foreskin may be red, swollen, and tender.
- The foreskin may not be able to retract.
- The foreskin may tight or constricted
Antibiotics, either oral or topical may control the infection. Hot soaks may help separate the foreskin from the glans. If they fail, a small incision is made to release it. Circumcision is generally advised when the inflammation clears.
The penis is much less frequently injured than other parts of the body, such as the abdomen, legs, arms and head. However, it can be wounded as a result of various injuries, including automobile accidents, gunshot wounds, burns, sexual activity and, in the case of mental disturbance, self-mutilation.
Perhaps the most common injury to the penis occurs during sexual activity. In the flaccid state, injury to the penis is rare because of the mobility and flexibility of the organ. During an erection, arterial blood flow causes the penis to become rigid, thus placing it at higher risk for injury.
Penile fracture. Although there is no bone in the penis, urologists frequently refer to the injury as a penile fracture. During vigorous thrusting, the erect penis may accidentally slip out of the vagina. Due to the fast action, the penis strikes the outside of the woman instead of being reinserted into the vagina. The penis may then bend sharply despite the erection. A typical sign of this problem is a sharp pain in the penis joined by a popping sound. The pain and sound are produced by a rupture of the tunica albuginea, which is stretched tightly during the time of an erection. The pain may last for a short time or it may continue. The penis develops a collection of blood under the skin called a hematoma, which can distort the appearance of the penis (eggplant deformity). The injury is usually limited to one or both of the corpora cavernosa and, on rare occasions, the urethra.
Other injuries. The penis can also be injured by tearing the suspensory ligament, the structure that supports the organ at its base. Attached to the pelvic bone, this ligament can rip if an erect penis is pushed down, suddenly causing pain and bleeding. Further injuries can occur if a man places a rubber tube or other instrument around the base of the penis that is too tight or on for too long. Cutting off the blood supply, it can produce a wound known as a strangulation lesion. Also, if an object is inserted into the urethra, both it and/or the penis can be injured.
If a man sustains a penile injury, a urologist will
- Take a thorough medical history
- Complete a physical examination
- Order blood and urine tests
The focus of any initial examination is to define the injury and assess the damage to the penis. Given that information, the doctor may call for other tests including:
- Retrograde urethrogram if he/she thinks the urethra is involved
- Ultrasound or MRI of the penis
Treatment for a penis fractured during sexual activity will probably be for the individual to undergo surgery, as it has the best long-term results by lowering complication rates often linked to non-surgical approaches.
For massive injuries to the penis, major reconstruction is frequently possible by urologists who are experienced with this difficult surgery. How closely the reconstructed penis can return to normal urinary or sexual function varies greatly.
Many cases of fractured penis caused by sexual activity and most other minor penile injuries will heal without problems. However, complications can and do occur. Possible complications include:
- Erectile dysfunction (due to blockage of the nerve or blood supply to the penis)
- Fistula formation (urine may leak out of the urethra and through the skin of the penis to the outside)
- Curvature of the penis after the injury has healed
Failure for the return of sufficient sexual function is dependent upon the degree of injury to the arteries, nerves, and corpora cavernosum, and whether the patient was experiencing erectile dysfunction just prior to the injury.
This article was originally authored by Allen Seftel, MD, formerly of Case Western Reserve University, and published on NetWellness with permission.
This article is a NetWellness exclusive.
Last Reviewed: Jul 03, 2010
Ahmad Hamidinia, MD
Professor of Clinical Surgery
College of Medicine
University of Cincinnati