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Recently, a United Kingdom-based 40-year-old-man has made a medical history of penile fracture, and become the first man to break his penis, vertically. Although there are many cases of horizontal penile fracture, this rare occurrence of vertical penile fracture has been encountered for the first time.
The case of the man, which is first of its kind, was reported in the BMJ Journal under the heading "Atypical presentation of a vertical penile fracture", with Dr Sam Hughes, a Urologist being the head of the study along with two other Urologists and a Radiologist. 
So, what exactly is a penile fracture? What are the causes, symptoms and treatment methods for the condition? Let's get to the details of these questions.
What Is Penile Fracture?
A penile fracture is defined as a fracture in the penis or tear in the tunica albuginea which is a thick and tough fibrous layer of connective tissues that surrounds the corpora cavernosa of the penis or say, tissues that are responsible for the erection of the penis.
A penile fracture occurs when the penis is erect and then subjected to an abnormal ‘bending' force. This sudden and acute force increases the pressures in the base of the penis, causing the erectile tissues to stretch or expand above their tensile strength (approximately 1500 mm Hg), leading to tear, rupture or fracture of the tunica albuginea. 
Studies say that the majority of penile fractures (88.5 per cent) occur during sexual intercourse. Also, it is prevalent in middle-aged men, probably who are between the age group 30-50 years.
Though patients with a penile fracture are mainly heterosexual males (men who have sex with women), some studies also say that around 1.8 per cent of penile fractures were also reported in MSM or men who have sex with men. Penile fracture can occur regardless of sexual orientation. 
Another study has also shown that most of the cases of penile fracture occurred disproportionately during summer and weekends. 
What Are The Causes Of Penile Fracture?
Some of the known causes of penile fracture are forceful bending of the penile during certain sexual positions like female-superior (the woman on the top and man on the bottom) and rear-entry that includes doggy-style, sea horse and penguin positions. 
In sexual positions in which the woman is on the top, there is a momentary blockage of the penis at the vaginal entry. If the weight of the woman is more or there's a sudden pressure put on the erected penis by the partner, or there's too much movement of the penis in the forward and backward movement, the chances of penile injury increase.
Some of the other causes include masturbation injuries, traumatic masturbation, accidentally falling on an erect penis or ‘taqaandan', a practice of penile cracking in some Middle Eastern cultures.
What Are The Symptoms Of Penile Fracture?
Some of the symptoms of penile fracture include:
- Pain in the genitals.
- Pain in the area surrounding the genitals
- A ‘pop' or ‘snap' sound at the time of fracture.
- Abnormal bending of the penis.
- Sudden swelling in the penis.
- Dark bruising above the fractured area.
- Difficulty in urination
- Blood leaking from the penis.
- A sudden release of penile tension or loss of erection.
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- Painful erections
- Formation of pus in the penis
- Severe bending of the penis
- arterial-venous fistulas or red, swollen and bulging veins in the penis which can be seen through the skin.
- Infection due to the collection of blood outside the blood vessels due to tears.
Though the aforementioned symptoms are commonly experienced by patients with the penile fracture, the 40-year-old, who has reported a new case of vertical fracture in the penis, does not report any such ‘popping' sound or rolling of the penis.
"The patient reported that his penis buckled against his partner's perineum. Interestingly, he described a gradual detumescence, with moderate swelling but no ‘popping' sensation. Moreover, there was no palpable ‘rolling' sign on examination. Given the presentation, a penile MRI was deemed appropriate in order to exclude a ruptured dorsal vessel and/or suspensory ligament.", the study says.
What Are The Complications Of Penile Fracture?
Some of the commonly reported complications of penile fracture include: 
How To Diagnose Penile Fracture?
Early identification of penile fracture is important for its early treatment. Also, sometimes, the pain in the penile is considered normal by many, thus leading to delay in the treatment. If you have a suspicion of a tunica rupture, confirm the condition by seeing the aforementioned symptoms.
A medical expert with diagnosing penile fracture through methods like:
- CT Scan: To identify the location and size of the injury. 
- MRI: To further confirm the identification of the fracture. 
- Physical examination: It includes examining the penis to look for signs of fracture such as blood in the opening or bending of the penis.
- Surgery: This is considered to be the only treatment method to correct the fracture. The surgeon stitches the tear with the goal to maintain the patient's sexual health such as maintaining their urinary functions and erections. 
- Medications: It includes anti-inflammatory medications to lower the pain and swelling of the penis.
- Complications-preventive measures: This includes methods to minimise the risk of long-term complications of penile fracture. It involves methods like compression bandages, penis splints, erection-preventing estrogens, antibiotics and drugs to prevent the formation of blood clots.
In the case study of a 40-year-old, it was mentioned "The MRI confirmed a vertical disruption of the tunica albuginea at the ventral aspect of the right corpus cavernosum, along with the medial third of the penile shaft. Guided by the MRI, the surgeon was able to target his exploration, confirming that indeed there was a 3 cm vertical tear. Unfortunately, due to COVID-19 restrictions, medical photography was prohibited".
What Are Treatment Methods For Penile Fracture?
The treatment of penile fracture should be prompt as in most cases, the pain due to fracture or bending of the penis is severe, and if left untreated for a while, the functioning of the penis may get affected.
Some of the treatment methods for penile fracture include:
As far as the vertical penile fracture of a 40-year-old is concerned, more research is required in the area. This is because its classification is not associated with regular penile fracture, probably because of no ‘popping' sound and noticeable rolling defect. The right way to treat the condition is early diagnosis followed by prompt surgery.
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