title: Penile fracture seems more likely during sex under stressful situations.
abstract: BACKGROUND
  The unusual event of penile fracture occurs when there is a disruption of the tunica albuginea surrounding engorged erectile tissue during aggressive sexual behavior. There is often an audible crack and rapid detumescence with subcutaneous hemorrhage that follows.
  
  
  OBJECTIVE
  Medical literature has described the etiology and treatment of penile fracture. We report the remarkably unusual social situations of a series of patients who sustained this unique injury.
  
  
  METHODS
  We conducted a retrospective chart review of 16 patients whose injury was severe enough to require surgical repair at the University of Maryland between 2007 and 2011. Particular attention was paid to the intake interview in the emergency department and the postoperative chart notes by the attending urologist to ascertain out-of-the-ordinary social situations in which the injury was sustained.
  
  
  METHODS
  The occurrence of penile fracture is sufficiently rare that the author was able to interact personally with most of the patients. The patients were remarkably forthcoming with the personal social dynamics of the sexual encounter.
  
  
  RESULTS
  Half of these penile fracture patients sustained the injury during an extramarital affair. Only three patients sustained the injury in a bedroom; the remainder was in out-of-the-ordinary locations for sexual intercourse, e.g., cars, elevator, the workplace, and public restrooms.
  
  
  CONCLUSIONS
  Penile fracture patients appear to be a unique population of men who are having sexual intercourse under stressful situations. Extramarital affairs and out-of-the-ordinary locations appear common in patients sustaining this relatively rare injury.
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. akramer@smail.umaryland.edu
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Kramer
mesh_terms: D000328:Adult; D005114:Extramarital Relations / Q000523:psychology*; D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000209:etiology*; D010413:Penis / Q000293:injuries*; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture / Q000209:etiology; D012725:Sexual Behavior / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D014947:Wounds and Injuries / Q000150:complications*