Dr. Andrew Kramer, a urologist and assistant professor of surgery at the University of Maryland Medical Center, studied 16 cases of penile fracture between 2004 and 2011 that required surgery. Half the patients admitted to fracturing their penises during an extramarital affair.
According to the study, which was published last month, penile fracture occurs when the "tunica albuginea" -- the fibrous membrane surrounding the tissue in the center of the penis -- is torn during the bending or buckling of an erect penis. It can result in erectile dysfunction if not surgically repaired.
We talked to Dr. Kramer to learn more about his unusual findings.
(Warning: Graphic content ahead)
Of the 16 patients in the study, 50% admitted to having an extramarital affair when the penile fracture occurred. Was that surprising? Why do you think that is?
I was... and it was a joke among the residents who'd come in. Some of the guys would say, "I'm sure he's with his girlfriend." If a guy is having an extramarital affair or he's rushed or in a weird place, the situation is different [somehow]. I think the time you don't see a lot of men fracturing their penises is in the bedroom with his wife that he's been married to for a number of years.
Not only were these men engaged in extramarital affairs when the injury took place, but they were also having sex in unusual locations -- outside the bedroom. Is there something to be said about where people carry on affairs?
That made sense to me. If the guy is having an affair with a coworker, I guess it makes sense that he would go about it at work, or he didn't want to come home. Maybe they were just trying to find whatever location they could... I think that a guy, when he's with a girlfriend or a co-worker and he's in a weird place, I think the sex might be different. He's extra excited and he's maybe doing more forceful or frequent thrusting, and the key is that he has less control over the angle that his penis can penetrate and that's what can predispose the fracture. If you're in an elevator with your wife or in a weird position it's the same risk, and it has nothing to do with an affair.
Your findings are based on 16 patients over a 4-year span. How can you be sure that your conclusions are accurate based on the limited number of patients in the study?
The paper is just observational; I'm just giving you opinions on it. I think it's pretty clear-cut that penile fractures have to occur from some buckling effect on the penis. About the affairs, I think it's the stressful situation and the unusual positions and the partners; I'm drawing a conclusion that is a lead from the data. In this type of study about penile fractures, it's hard to get thousands and thousands of patients. I agree that it would be great to pull data from other people and institutions.
You note that the incidence of penile fracture may be higher than reported because patients may be too embarrassed to report their injuries. Can you speak to that?
Oh, for sure that's the case... If I had an injury and I was embarrassed, I might stay home and say "God I hope this gets better." I think a lot of guys are not going to come to the emergency room for that reason. They would rather hope it goes away or they don't want to tell someone at home.
You treated many of these patients yourself. What was it like talking to the patients' wives after they confessed to you?
It is awkward. I don't feel any ethical obligation to tell a wife that her husband was cheating on her. I really have not felt that it's my duty, and I'm not embarrassed about it... I'd just say, "We fixed the penis... there's a tear." If she wants to ask him later, then that's up to her. I think in terms of confidentially, I'm not obligated to tell them, so I never do.
What advice would you give to men based on your findings?
I think a man has to be extra cautious. Most of the time, it doesn't matter who you're with, the position where a man fractures his penis is typically when a woman is on the top and she comes down on the erect penis and it buckles. Protect that penis from getting buckled, or getting hit at an angle, because that's where it'll happen.
