Penile fracture: Popping sound may be bad omen

Report of a distinct cracking, popping, or snapping sound during sexual intercourse, followed by immediate loss of erection, increases the probability of having penile fracture as opposed to when a sound is not reported, according to a study.

To assess the role of a popping sound in diagnosing penile fracture, researchers examined the medical records of 65 consecutive penile fracture patients (median age, 37 years) who presented to the emergency room after a median delay of 12 hours.

Most injuries took place during sexual intercourse (80 percent). Of the patients, 64.6 percent reported hearing a sound and 93.8 percent experienced detumescence. There were nine patients (13.8 percent) surgically diagnosed with false penile fracture, and two of them reported the sound.

Sound was the most significant predictor of surgically diagnosed penile fracture (relative odds ratio 4.25). The probability of penile fracture dropped from 92 percent to 74 percent in the absence of sound among patients injured during intercourse who experienced immediate detumescence.

Data on the incidence of false penile fracture and the greater proportion of these patients not reporting the sound are in line with previous studies. [Urology 2010;75:1353-1356; Int J Impot Res 2007;19:471-473; Urol Ann 2014;6:23; Urology 2010;76:1488-1492]

However, the researchers cautioned that the snapping or popping sound is a patient-reported clinical sign with issues regarding its reliability. In addition, although the absence of such a sound seems to be the most notable feature of false penile fractures, other clinical clues characteristic of a less severe injury, such as postinjury erections and gradual detumescence, should not be overlooked.

The researchers also acknowledged that the report of a sound, however interesting and relevant, is not enough to challenge current diagnostic and treatment guidelines. Instead, the study represents an early step in the development of a clinical instrument—a score or nomogram—designed to increase diagnostic accuracy in men with clinical suspicion of penile fracture.