Is it true men can suffer penile fracture? The faux pas de coit

I am reminded of this "classic" column at Straight Dope (I highly recommend this site, and his books, which are among the best bathroom books ever) on occasion - today it was the BBC article on couples getting stuck together during sex - a year or so back it was when the girlfriend of MMA fighter Ray Elbe got a little overexcited during sex and misjudged her landing.

Dear Cecil:

I was told my local hospital was home to one of the nation's leading experts in, catch this, penile fractures. This has me worried, Cecil. How might it happen that I would, you know, break it? Is this a hazard of everyday life? Are there any preventive measures I might take?

— M. Toulouse-Lautrec, Chicago

Cecil replies:

Cecil has heard about some stupid injuries in his day, but penile fracture takes the cake. Offhand you'd think the penis would be immune to fracture, since it contains no bones. It does get rigid, however, and things that get rigid can break. At risk are the corpora cavernosa, the two tubelike masses of tissue that run through the center of the penis. They become engorged with blood during sexual arousal and cause the penis to become erect. Each corpus cavernosum is covered with a fibrous sheath, which during erection gets stretched pretty thin. A sudden jolt in the wrong place and you could pop like a balloon. In severe cases, the urethra (through which urine passes) and the outer sheath of the penis can also be damaged.

Most men recognize their vulnerability and take appropriate precautions, but a few meatballs evidently don't. As of 1985, about 180 cases of penile fracture had been reported. In about a third, fracture occurred as a result of what is called — and leave it to the French to have an expression for this — a faux pas de coit. Here are some typical cases:

• A 31-year-old man was having sexual relations approximately 1-1/2 hours before admission to the hospital. He "missed the introitus [and] hit the perineum [the area behind his partner's genitals]," causing his penis to fracture (my emphasis).

• A 67-year-old minister, obviously taking the parable of the good seed to heart, was having intercourse when his "penis rammed [the] mattress." He began to bleed profusely and experienced pain and swelling.

• A 26-year-old male … experienced sudden acute pain and prompt detumescence during vigorous coital activity. The episode was associated with an audible cracking sound [and] his penis became grossly swollen."

Now, far be it from me to add insult to injury, but how could you be so klutzy that you "missed the introitus"? Admittedly the target is small and the visibility isn't the best, but we're talking point-blank range here.

The other cases are just as goofy. Frequently the victim suffers the injury while kneading his member in order to reduce an erection, a technique that in my experience usually has the opposite effect. One moron "awoke during the night with a desire to urinate," whereupon he "hit his erect penis with his hand in order to alleviate this desire." Other reported causes: rolling over in bed, hitting the bedpost, getting caught in your pajamas, falling out of a tree, being thrown against the knob of a motorcycle saddle, and so on.

Fracture always occurs during erection, making you wonder what some of the victims were up to. Consider one case involving a 38-year-old ranch hand. "The [medical] history was vague and difficult to obtain," the reporting physician writes. "The injury had occurred in the corral. It was impossible to get the exact details … His family was of the opinion that he had been kicked by one of the horses." Tell it to Catherine the Great, buddy.

In the old days treatment consisted of splinting, ice packs, insertion of a catheter (sometimes), and rest, augmented by drugs to suppress erection while the injury healed. However, such treatment sometimes resulted in permanent deformation and inhibited sexual performance. Accordingly, many doctors today recommend repairing the damage surgically — not a pleasant thing to watch, judging from the pictures. The operation is fairly straightforward, but there's obviously not much room for error. One thing's for sure: if this ever happens to you, make sure you get a surgeon who's more coordinated than you are.