Q&A: Harvard Doc Who Treated Man with Broken Penis

Don't try to ice it, he says, just get to the ER.

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Surely, you saw the news earlier this month where Dr. Robert Hartman, a urologist at Brigham and Women’s Hospital, found himself in the spotlight after publishing a brief case study of a fractured penis in the New England Journal of Medicine’s “Images in Clinical Medicine” series.

The study included a picture—obviously NSFW—that featured the bruised, eggplant-like penis of a 42-year-old man, whose member “collided with his partner’s perineum” and fractured. Naturally, I had a lot of questions, and fortunately, Dr. Hartman was willing to discuss everything, from the highest-risk sexual position, to Reddit’s AMA on broken junk, to Jimmy Kimmel’s recently disclosed penile problems.

How long have you been practicing urology and how many fractured penises have you encountered?

I have been in Boston with the Harvard program in urology for about five years. In my time here, across the five institutions that we work in, I’ve dealt with a little over a handful of penile fractures—somewhere in the neighborhood of five to seven.

So it’s rare?

Fortunately this is not a very common problem. However, what we say is that it’s not infrequent. It’s not unheard of to get a consult from the emergency department to come in and take a look at a guy’s penis that’s a little black and blue. The actual prevalence of the condition is difficult to ascertain, but there are some papers that suggest it’s about 1,000 cases per year. But again, it’s a very rough estimate.

So if this happens to a guy, what should he do? Would immediately icing the injury help, or is there anything the person can do to start treating the injury right away?

Unfortunately there isn’t. There was a very good study last year from researchers in Illinois that looked at about 30 patients. And it showed that of those patients, most of them had a delay in presentation to the emergency room—about 12 to 14 hours after the accident. If you think about it, it’s completely understandable. I imagine that these guys sort of want to sleep it off and wake up hoping that nothing really happened, that it was all a bad dream. But in reality, they would be best served to present immediately to the emergency department for medical attention and urologic evaluation.

Is the general reaction among lay folk, “I had no idea I could break my penis”?

Yeah. It’s sort of in the back of our heads. We all have this sort of fear that’s inherently part of being a man, that it could fall off or something. But we don’t really appreciate the possibility until we read about it in the newspapers.

Most of us hear the word fracture and think a bone has to be involved. What exactly is fracturing?

You know, it sort of is a misnomer. When you hear fracture, you think of a splint or a cast—certainly it’d be very odd to walk out of the emergency room with a cast on your penis. And it would certainly be very awkward to ask for a signature. So what’s actually breaking is the fibrous sheath. And it’s really a crack in that sheath. There’s a break that we look for when we repair the fracture with a couple of stitches. We just re-approximate the torn edges and re-establish continuity of that sheath, which is called the tunica albuginea.

The mechanism of the injury is always the same. There are two cylinders within the penis that become rigid with an erection. Whenever these cylinders bend in a fashion in which they’re not intended—oftentimes either striking the partners perineum [medical term for grundel or taint] or pubic bone—it can result in a fracture or a break in those cylinders.

Is there anything that couples can do to mitigate the chances of this happening?

Yes. There was a recent study from Brazil in the past year, which actually suggested that there are certain sexual positions that put men at a greater risk of fractures than others. And, as I’m sure you probably saw on Reddit, the one at the top of the list is reverse cowgirl—the woman on top facing away from the man. But really, it’s any position that would compromise the man’s ability to halt or slow down entry.

Essentially if the guy can’t avoid missing, then he’s at a risk of fracture. So again, if a woman is on top facing away from the guy, and she’s not paying attention, and the penis is an odd position, it’s sort of a recipe for disaster.

That study from Brazil interestingly also found that about 50 percent of these injuries occur in men committing adultery, and that over 50 percent of those injuries occurred outside of the bedroom. Under all these conditions—the position, the social circumstance, or the physical location—there seems to be an element of stress that’s sort of the underlying culprit.

You could publish a groundbreaking study in urology and perhaps not receive the type of attention that you’ve gotten from publishing a picture of a fractured penis. Is that frustrating?

Yes! Within my own department here at Harvard, there are a number of world-renowned urologists that are in the process of doing real groundbreaking research that will have very real impacts on the lives of thousands of men and women. And they all shake their heads when they see that there’s this dick pic, for lack of a better term, gracing the New England Journal of Medicine.

In the NEJM article, you noted a “rush of blood from the meatus.” Two questions: What is the meatus, and what does blood rushing from it indicate?

The meatus is the hole that you pee out of—it’s just a fancy word. If there is blood present, which isn’t always the case, what it suggests is that not only have you fractured those erectile cylinders, but you’ve also fractured the urethra. So now that blood can get out of those cylinders, it can also leak into the newly opened urethra and leak out of the meatus at the tip of the penis.

Have you seen all the news about Jimmy Kimmel’s penis? Seems like his meatus was closing up?

Yeah. It’s unrelated [to penile fractures] however. What it sounds like he’s describing is something called meatal stenosis. We see this frequently at Boston Children’s Hospital. What can happen is that the opening at the tip of the penis can slowly come together and obstruct the urinary stream. Initially it causes spraying of the urinary stream, and in some kids it can get so bad that they can’t urinate at all.

So you’re a fan of Reddit and have seen the “Ask Me Anything” with the gentlemen who broke his penis?

Yeah. There is a lot of very good information on Reddit, but as we caution all our patients, you really have to be careful about what you read on the Internet. I bet a lot of guys were fairly freaked out when they read that article.

When you took the picture of this patient’s penis, did you immediately think, “this is gold for NEJM’s Images in Clinical Medicine series?”

I’m not too sure what I was thinking. We tend to include a lot of these pictures immediately in the medical record, and then we get rid of them. Oftentimes we’re taking them with our cellphones. We have strict regulations in getting these pictures off our devices immediately. In combing through my records for some fodder for the Clinical Images section, this particular patient had such a beautiful eggplant deformity that we had a hard time ignoring it.

How do you feel about being known as the “broken penis doctor” on the Internet?

When my dad caught wind of this thing, he gave me a call and he said he didn’t know if he wanted to hit me over the head or pat me on the back. And then my mom told me she wasn’t going to hang the article on the refrigerator. I would have never imagined “broken penis doctor” next to my name when I Google myself. There’s certainly a good deal of humility that comes with this profession. Urologists get peed on all day, so we have to have a very strong element of humility and accept being humbled by our profession.

And the patient from this picture is doing well?

Yeah. As long as guys can sort of swallow their pride and get to the emergency room, they’re usually seen by a urologist very quickly. Over the course of time, their erectile function is preserved about 90 to 95 percent of the time. Now if you don’t make it to the emergency room for whatever reason, or if you refuse surgery, then that 95 percent drops all the way down to 50 percent as they develop scar tissue and subsequently have secondary issues.