You Think the TREE Is Crooked: Penile Fractures Up at Christmas

Talk about taking a break for the holidays: A new German study found that penile fractures are more likely to occur around Christmas Day.

From 2005 to 2021, 3,421 men in Germany required a hospital stay for penile fractures, with 1.2% occurring from December 24-26 in each year, reported Nikolaos Pyrgidis, MD, MSc, of University Hospital, LMU, in Munich, and colleagues in BJU International.

The daily incidence of penile fractures — ruptures that can occur when the erect penis is bent too far during adventurous sexual intercourse — during Christmas was 0.78, with an incidence rate ratio (IRR) of 1.43 (95% CI 1.05-1.95, P=0.02).

Perhaps surprisingly, only 28 penile fractures occurred during the New Year’s Eve period (IRR 0.98, 95% CI 0.69-1.5, P=0.98). However, Pyrgidis and team — who didn’t look at other German holidays — noted that New Year’s isn’t celebrated as much in Germany as in some other countries.

It’s not clear why yuletide leads to more injuries. The authors don’t speculate about potential risk factors such as heightened eggnog consumption, the seasonal appearance of Sexy Santa lingerie, or it-only-comes-once-a-year willingness to get especially frisky.

Whatever the reasons for the bump in cases, South Florida urologist Justin Dubin, MD, doesn’t think couples need to spend much time worrying about unexpected emergency department visits due to wayward lovemaking.

“If you want your stocking stuffed on Christmas, go ahead,” said Dubin in an interview after he reviewed the “awesome” paper. “This shouldn’t prevent you from doing anything that you want to do with your partner just as long as you’re communicating and enjoying each other. If you have aggressive sex, that’s great. Just be conscious of what you’re doing, and try to have control.”

Dubin said penile fractures are rare but urologists do see them on occasion. A 2019 study estimated that there were 8,029 emergency department visits for penile fractures in the U.S. from 2010-2014, a rate of 1.02 per 100,000 males per year.

While there is no bone in the penis — never mind the use of the term “boner” for an erection — the injuries are called “fractures” in the medical literature. They occur when penises get bent enough to cause ruptures in the lining of the corpora cavernosa, the penile tissue that holds blood during erections. According to Dubin, the lining — the tunica albuginea — is similar to the casing around a sausage.

Men often hear an audible “snap” during intercourse, which is the sound of the lining rupturing, he explained. Blood is then released into the penis where it causes swelling and a trademark “eggplant” appearance.

Untreated penile fractures can lead to impotence, persistent pain, urethral injury, and curvature of the penis.

There’s debate about which types of sexual activity can cause penile fractures by bending the erect penis too far. According to the Sexual Medicine Society of North America (SMSNA), “penile fracture could be possible in any sexual position, but research indicates that ‘doggy style’ and ‘partner-on-top’ (often called ‘cowgirl’ or ‘reverse cowgirl’) may be the most frequent culprits.”

In these types of intercourse, there’s a risk that the penis will hit the pelvis or thigh and bend too far, Dubin said. Penile bruising is also possible, but a sure sign of a possible penile fracture is an inability to get an erection, he added.

As the SMSNA noted, research has linked penile fractures to extramarital affairs, unusual locations, and a Middle Eastern practice called taqaandan “that involves physically bending an erect penis until it ‘clicks’ or ‘snaps’ to make an erection go away.” (“Taqaandan is said to be painless and has been compared to cracking one’s knuckles,” a 2013 study reported, and a 2012 book noted that the practice can provide relaxation and even be a pleasurable habit.)

The injuries can also occur in men who are being treated for a penile curvature condition called Peyronie’s disease.

As for theories about why Christmas might boost the risk of penile injuries — at least in Germany — Dubin said the answer may be simple: “Rates are probably higher because people are more intimate with each other and happy to express their love.”

For the study, the researchers analyzed German Nationwide Inpatient Data from the Research Data Center of the Federal Bureau of Statistics. The 3,421 patients who required hospital stays for penile fractures had a median age of 42, and stayed in the hospital a median 3 days. Most (76%) required surgery, and the median cost for treatment was 2,358 Euros, or about $2,600 at the current exchange rate.

The researchers looked at cases by day and month and found that penile fracture admissions were especially common on Sundays (22%) and Saturdays (17%), on weekends as a whole (IRR 1.58, 95% CI 1.48-1.69, P<0.001), and during the summer (IRR 1.11, 95% CI 1.03-1.19, P=0.008), especially June (IRR 1.14, 95% CI 1.01-1.28, P=0.03).

“Based on our analyses, penile fractures occur in periods when couples are enjoying moments of relaxation such as Christmas, weekends, and summer,” Pyrgidis and colleagues wrote. “On the contrary, our findings do not support Elvis Presley et al. stating that ‘For if every day could be just like Christmas, what a wonderful world this would be.'”

As for limitations, the study authors noted that coding in the inpatient database could be wrong, and the total number of cases is quite small. The study also doesn’t examine the sexual practices that led to the penile fractures.

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