Sharp pain - possible fracture?

[Orome]

So last night I had an injury.  I had a 100% erection and a lot of force was unintentionally applied to the side of my penis which caused a very sharp pain and I quickly lost my erection.  Following the incident I felt mild discomfort, the area was a little red.  I took an Ibuprofen and Vitamin E after the incident and went to bed.  It's been 24 hours and there is no huge swelling or major discoloration like you would typically see with a penile fracture, but I do have two small semi circumferential bumps in my flaccid penis where the injury occurred and it's slightly red.  
 
Is this most likely swelling or lymphatic tissue?  

How likely is it to have a penile fracture without the huge swelling and discoloration?  

Are there different grades of penile fracture?  Possibly a partial tunica tear but not complete?  I'm just worried it could be a minor one.  It was a very sharp pain when the injury occurred and I typically have a high pain tolerance.  

[nemo]

I completely appreciate your being worried and coming to this forum for counsel and hopefully reassurance.  But in truth, you need to go see a Urologist as soon as possible. There is simply no way a bunch of guys on the internet can assess your situation simply from a description - you need to be examined in person.  

Not the answer you were looking for, I know, but that's the size of it. All we can do is speculate, and that's potentially detrimental.  So you really need to see a doctor.  

Best,
Nemo

[Orome]

Quote deleted by moderator - James.
Please read the forum rules!!!

Thanks for the response, I actually did got to urgent care today.  The urgent care doctor looked at it and didn't seem too concerned, he told me to follow up with a urologist, but it will be almost 2 weeks till I can get in to see one.  He said I could go to the ER and get a full workup (ie ultrasound) but he didn't think it was necessary at this point unless the swelling gets worse.  Still doesn't quell all of my worry.  I hear early diagnosis and treatment is very important in this type of injury if you want to avoid long term complications.  

It's rare, but I have heard of cases of partial tear that doesn't clinically manifest as your typical penile fracture initially (where it does later due to further injury).  

[bballfan70]

You should definitely go see a urologist but if its of any comfort to you, I had a similar injury/ incident with lots of pain.. After reading lots on the web, I was freaking thinking I fractured.  My doc assured me thst you would absolutely know, with severe bruising like an eggplant.. No doubt you injured but hopefully not as extreme as you think..  

[Orome]

Quote deleted by moderator - James.
Please read the forum rules!!!

Thanks.  That's pretty much what the urgent care doc said, you would see lots of bruising and swelling.  That's what I figured till I came across this guy's story: IAMA 39 y.o. guy recovering from emergency penis surgery last night. My injury occurred during vigorous sex with my wife. AMA and yes, prepare for TMI. : IAmA

He had a penile fracture with pain but no initial swelling and bruising.  It's probably very rare for that to happen.  

[Orome]

Didn't realize there were rules about quoting.  Anyways.  The semi - circumferential lumps have gotten a little bit bigger after waking up in the morning, still not discolored and painful.  

I know nobody can diagnose me over the internet.  I just didn't realize you could have blood leaking into the corpus spongiosum and still have a penile fracture without the swelling.  I don't know how rare this is, but it seems the general opinion most doctors have is a fracture will be accompanied by major bruising and swelling.    

[bballfan70]

Remember things you read on internet are always worst case scenario. We all do it, when I first started with my problems I scoured the internet and freaked out over every story comparing to my story.. Try not to, it will drive you insane

[Orome]

That's a good point.  Right now I'm just trying to decide between going to the ER for a proper diagnosis (but expensive) or waiting a week and a half to see the urologist.  

[james1947]

Quote from Orome:

He had a penile fracture with pain but no initial swelling and bruising.  It's probably very rare for that to happen.

I had the same. Maybe is not a very rare thing. Also the pain gone after 3 days.

James

[Jonbinspain]

I would agree 100% with Nemo. There is no way any of us can make an accurate diagnosis/assessment of your condition, see a doctor ASAP.  

[Orome]

james1947 You had a penile fracture without initial bruising and swelling?  How did they diagnose it?  Did they surgically repair it?  

[james1947]

I had a penile fracture without "much" bruising and swelling that gone in a short time.
It was a crack noise and very sharp pain, same as I had while braking my right fibula.
I was not thinking that is possible to fracture a penis as don't have any bones there.
I was diagnosed after 3 years as I didn't sought any help until discovered this forum.
They didn't surgically repair it. It will be done in the future if I will have the financing for it.

James

[Orome]

James, did you experience persistent erectile dysfunction and bending as a result of the injury?  

[james1947]

Yes. It just come very slowly.

James

[Orome]

I see.  Seems like the injury like this is something that can set off peyronie's in those that are predisposed to it.  I do not know yet if I actually have peyronie's, but I'd rather not take a chance.  

I consulted with an online urologist giving him a picture of the injury and a very comprehensive description (more than I've given here).  That's the first time I ever tried that, he was actually very helpful.  He told me "it appears that you have sustained trivial injury to tunica albuginea resulting in to minor bruising and prominence of two tributaries of dorsal vein of penis".  He suggested getting an ultrasound at my earliest convenience but seemed to indicate that more than likely it isn't the same level of trauma you would need emergency evaluation/surgery for.  
Normally I would just get in to see my urologist and get the ultrasound as soon as possible, but this couldn't have come at a worst time for me and I am far away from home and out of network.  

[Orome]

I saw another uro.  He felt around and told me it didn't sound like a fracture.  I never mentioned any popping sound, there was loud music playing when the injury occurred.  I wonder if that factors into his reasoning?  He didn't want to order an ultrasound.

It has been 1 week and I still have two hard lateral lumps and pain where the injury occurred.  I still want to get a scan done to rule out any major injury, but at this point isn't it a little to late if there was a minor fracture?

[james1947]

Orome

You must see a doctor that will be ready to make you an ultrasound to be sure.
To your question:

isn't it a little to late if there was a minor fracture?

No.

James

[Orome]

Well I have an appointment with a different doctor on Monday.   Hopefully I can get to the bottom of this.  Still no major bruising, but the pain seems to be worse now than it was the day after.

[Orome]

I don't know yet if I have peyronie's or not, I had a doctor about a year ago tell me I might have felt a very slight plaque.  I just want to make sure I catch it early if I do have it as I heal from this injury.  Are there any other early signs I should look out for?  

I've been told I may have had a small tear in the tunica albuginea that clotted itself or just a bruised tunica causing the lumps.  In either case I'm just really hoping it is able to heal without deformity or dysfunction.  Still seeing other urologists, most don't seem to want to order an ultrasound.  I don't understand why not.  

I can start on coq10 or vitamin E, but I don't know if that will effect the healing process as those can effect clotting and increase bleeding risk (which would be a bad thing if I started bleeding out of the tunic albuginea during an erection).  

Do people with peyronie's heal wounds differently in other areas of the body, or is it mostly localized to only the penis?  

[NeoV]

Localized, or sometimes also causes Dupuytren's in the hand or ladderhouse on the feet but this from my understanding is not actually that common together, only correlated, and is likely to come later in life. My father got Peyronie's at 27 and Dupuytren's at 60 or so.

I think supplements are always worth it, also cialis and pentox. These drugs and supplements have clearly been shown in studies (if you ask me) to prevent fibrosis after injury. Anything that increases nitric oxide expression, blocks tgf-beta, or is a PDE inhibitor helps. Moreover, anything that improves vascular health is helpful along with antioxidants.

The problem is that not many people here will give you a definitive answer as to what to take now, but at the same time we all regret not taking these oral substances sooner. Look at studies, on humans or rats and make a decision. If I were you I might be taking all that stuff.

[Orome]

Thanks, I'll look into it.  I have had good healing before in different areas, major injuries, but I'm just worried about how my penis will heal and want to be as proactive as possible without doing further damage.  

[NeoV]

Healing from vascular damage is not pretty when dealing with the penis..

I wish I could advise you better. If I was a doctor and you were my experiment with no repercussions I would put you on THE LOT of supplements, without a doubt. If you were my son, I would put you on the lot of supps and drugs immediately without hesitation. I however cannot be responsible for any negative results you may experience and I can guarantee nothing. I would love to hear Lue's answer to your question.. So you should have a specialist see you immediately. A Peyronie's specialist, see one AT ALL COSTS. He, rather than I, can look at you and say "yup, get on pentox and cialis and the lot of supps NOW", if that is actually his opinion. I would go so far to say that this is likely to be his opinion.

My own opinion?

Supps: Citruline, Grape Seed Extract or Pine Bark, CoQ10, Acetyl-L-Carnitine, vitamin D, vitamin K, and anything helpful to endothelial health.

Drugs: Cialis, Pentox

[james1947]

Orome

I read again all your posts.
I understand that you have many problems, for long time:

I had a doctor about a year ago tell me I might have felt a very slight plaque.

But still didn't see a Peyronies specialist and also not making any treatment.
You have written also:

In either case I'm just really hoping it is able to heal without deformity or dysfunction.

It will not happen without treatment if you have Peyronies.
NeoV and other members are trying to help you based on they experience and knowledge, but they effort can't replace a visit/diagnosis/treatment by a good urologist/Peyronies specialist.

James  

[Orome]

Thanks James.  Does anyone know of a good Peyronies specialist in the southwest US?  It is a hit and miss with urologists.  

Edit: I just found two within my city on http://www.peyroniesassociation.org.  Don't know if that mean's they are a specialist, but at least it's a lead in the right direction.  

[Orome]

Supps: Citruline, Grape Seed Extract or Pine Bark, CoQ10, Acetyl-L-Carnitine, vitamin D, vitamin K, and anything helpful to endothelial health.

Drugs: Cialis, Pentox

I've had good results with Acetyl-L-Carnitine before the injury (helps with erection quality).  I do have that and Co Q-10.  Think I'll stick with those two until I'm able to see a specialist.  

Thanks for the info.  

[james1947]

Orome

You may find one close to you here:
https://www.peyroniesforum.net/index.php/topic,4063.0.html
Dr. Tom Lue is one of the leading Peyronies specialists, but he is more to the west than south west.
I hope someone will give you more specific answer, any case have other doctors than Dr. Lue in the south east that are OK according to forum members.

James

[james1947]

Orome

My problem with finding a doctor on a site like in the link you provided is that it is a commercial site that promotes certain doctors.
Maybe many of them or maybe all are very good doctors, but I would like to chose a doctor based on other Peyronies sufferers advice and not based on web "testimonies" and resumes.
By the way, they list including Dr. Lue and Dr. Gelbard that are much appreciated on the forum.

James

[Orome]

So I saw ANOTHER urologist today.  I requested an ultrasound, but they flat out refused.  They said "if it's done within 48 hours it can be surgically repaired, but if the 48 hours since the injury has lapsed nothing can be done about it and we don't like ordering tests that don't change the treatment".   Unbelievable, I'd be paying for it anyways (not insurance) but I cannot even get an ultrasound ordered to assess the damage done!  I have read other medical literature contradicting what the doctor said about the 48 hour window.  His recommendation, take vitamin E and see what happens.  

I know there's nothing anybody here can do about it, but I am just beyond a little bit frustrated.  What if there is long term damage that could have been repaired but multiple doctors refused to do a simple test to assess the damage from the injury?  

Moral of the story, if you injure your penis, get seen within 48 hours otherwise you may be flat out refused to get proper treatment.  

Sorry for just venting, but I'm beyond a little bit frustrated.  

[james1947]

Orome

First, we all need to vent sometimes and this forum is one of the places to do that, with other brothers suffering from the same problem.
Regarding ANOTHER urologist, you get another not competent doctor, so you must seek an competent one.
Strange for me that you are paying out from your pocket and he is not ready to make an ultrasound.
Don't give up, go and see Dr. Lue or Gelbard if you can.

James

[NeoV]

That sucks.

Regular urologists cannot help you. It's a waste of your time. There is very little you can do and an ultrasound probably wouldn't change your treatment. I'm sorry to hear about this urologist, it's just a sad reality that not many people can help. Make sure you see someone very reputable and then it's likely you can get at least a pentox script.

You need a true specialist though to at least help you make the choice to treat it orally. An ultrasound of course may make that decision easier too.

[Orome]

Well I saw 2 others, one from the list I posted, he was a bit better.  He told me he'd like to wait till this heals and do an ultrasound in a month.  He told me about a more bioavalible form of coq10, I asked him about pentox, he said he wasn't sure if it was necessary at this time but if I wanted he could write me a script.  So I got the prescription to that.  

Saw another urologist today who took one look at me and he told me it looks like I injured my tunica albuginea but there is nothing to do about it and no imaging for it either.  He told me the tunica doen't typically heal itself very well but "it's like spraining your ankle, it hurts to walk but there isn't anything to fix it"... great.  This seems to contradict a lot of what I see in literature about repairing damage to a injured tunica albuginea and how early surgical intervention is recommended.  

They seem to think that since I can get an erection everything is fine.  From what i've been reading the tunica albuginea isn't directly used in maintaining an erection, but it just creates the hardness of the erection as the tissue expands against the sheath.   *http://peyronies-disease-help.com/peyronies-disease-introduction/tunica-albuginea/

Pyronies is one concern, but it isn't my only one.  It's disheartening to have a urologist tell you there is nothing you can do about it and it's unlikely to heal completely on it's own.  

[NeoV]

Again, are these reputable Peyronies specialists? If not, forget it. Your first urologist seems to have some sense giving you pentox and knowing about ubiquinol. Ubiquinol shouldn't online be taken if you're over 40 years old. Take the supplements (and drugs if you like), and in yime your penis may slowly remodel itself with strong erections. It's certainly true that the tunica doesn't really heal well. That's why we are all here, discussing solutions. There is no true "fix" only maybe things that appear to help, in some cases restoring men to close to back to normal.

[Orome]

NeoV, the one that prescribed pentox does seem to up to date with Peyronies.  When I called to schedule an appointment the receptionist asked if I had Peyronies before I even mentioned it (most other places the receptionist/staff aren't even familiar with the term).  

I was just suprrized at the lack of care from urologists in the acute injury phase.  There is much literature that states early surgical intervention in the case of a tunica tear has a much better prognosis than conservative treatment (wait and see).  

I can still get erections so that's a good sign I guess.  I've been refraining from any sexual activity / masturbation because I don't want to make the problem worse.  The bumps on the tunica haven't really changed one way or another.  

If the tunica never really heal that well, then how are some people able to have a complete penile fracture heal up and are able to maintain firm straight erections after the injury?  

[nemo]

That gets to the very heart of why some of us are genetically disposed to Peyronies Disease and others are not.  Some guys might fracture their penis and then heal just fine, while we Peyronies Disease sufferers might incur a far less significant trauma and "over-heal" to the extent that the "healing" is worse than the injury.  That's the sad mystery of Peyronies Disease, I'm afraid.  

Nemo

[NeoV]

I see. Not to add any negativity but food for thought, what makes you think people actually fully "heal" from penile fractures?
I'm of course optimistic and hopeful that you will get some improvement with oral treatments and possibly physical therapy options (with extreme care).

[Orome]

NeoV, by fully heal I mean be able to come back to where they were in terms of erection quality without the aid of drugs, injections, prosthesis etc.  I'm sure there is some scar tissue.  The link I posted earlier in this thread of the 39 y.o. made a full recovery after surgery.  Reading medical studies, some are able to make a full recovery even after a traumatic penile fractured, some obviously do not and even require penile prosthesis etc.  My injury doesn't seem as severe as theirs thankfully, but it still has me worried.  I take some comfort in the fact that I can still get firm erections following the injury although they don't last very long.  

[Orome]

So I filled my pentox prescription, and I've been taking that with no side effects.  The urologist also gave me a referral code for NeoQ10 (a more bioavalible coq10 supplement), but it's pretty expensive.  I'm not sure if it's that much more beneficial taking along with the pentox.  Do they work on different pathways, or do they have a synergistic effect?  I'm just not sure if it's worth taking both.  I've taken a lot of different supplements in the past, but I try to limit the amount of things I'm continually taking.  

[james1947]

The most beneficial along Pentox is low dose Cialis.
CoQ10 is not connected to the above, many forum members reported benefits from it, also you can read on the web about Ubiquinol health benefits.
For your age (you have stated late 20's in one of your posts) CoQ10 will do the job.
The best is to take Ubiquinol, this what our body using. Check out the price differences.

James

[Orome]

Thanks James.  

I'm assuming Cialis is to keep good blood flowing in the area and for getting nocturnal erections?  I actually had a doctor prescribe Cialis to me (not for peyronies), but it is really expensive here in the states.  Not really affordable to be taking on a daily basis.  

[james1947]

Orome

Some researches are pointing that Pentox with low dose Cialis it helps softening the plaques. 5 mg if have ED, 2.5 mg if don't have ED.
Me and other forum members are buying from Riverpharmacy. You can cut 20 mg to 4 or 10 mg to 4 or 2.
https://www.riverpharmacy.ca/drug/cialis
One 20 mg pill less than $2.121, so daily $0.53, monthly $15.9.
You may find other Internet Pharmacies but I can't guaranty if it is a scam or not.

James

[Orome]

Thanks, that is more affordable.  

[Orome]

It's been 6 weeks, and things haven't gotten any better.  In fact the pain after erections has gotten worse.  I've taken it easy for the most part.  The lumps on my tunica have not gone away, the tissue underneath the skin in the area of injury still has a lump to it and just feels off.  Getting erect exacerbates this.  If I get an erection, the bumps get more prominent and my penis aches afterwards.  

Every doctor I saw said "O it should go away in 2 weeks or 4-6 weeks"  but it hasn't improved at all!   I'm just at my wits end.  I feel I should have been properly evaluated, and possibly had my tunica tear stitched back together, but no doctor would take me seriously since it wasn't a complete fracture rupturing the corporal bodies and causing gross bruising and swelling.  

I know I may have Peyronie's but I don't even know if my tunica albuginea is healing properly.  And I have no way to find out.  

[james1947]

Orome

You have stated:

It's been 6 weeks, and things haven't gotten any better

But from reading your other posts, you started treatment less than 3 weeks ago. It is not clear also what is your treatment, except Pentox. If you will read your last few posts, you may understand why I am saying that.
Regarding Cialis, are you taking?

Thanks, that is more affordable.

Regarding Cialis price
CoQ10? I have written:

For your age (you have stated late 20's in one of your posts) CoQ10 will do the job.

Also too expensive?
Oral treatments, VED, Traction are marathon and not sprint. Don't expect results too fast!!!
James

[Orome]

James,

I'm talking about 6 weeks since the injury.  I have been taking pentox, ordered cialis, I'm still waiting for it to come in.  I have CoQ10 but not the Ubiquinol/NeoQ10.   The thing that is eating me is, I can easily feel the defect in my tunica albuginea, and I'm not 100% convinced this isn't something I should have gotten surgically repaired.  My tunica feels rough and there are bumps / indentations at the site of injury.  

I'm still worried about the initial injury as it was not definitively diagnosed despite seeing 6 different doctors (4 urologists).   It could be a atypical fracture.  

[james1947]

Orome

I read again all your posts on this topic and I understand your frustration. In my opinion Pentox, low dose Cialis and CoQ10 will do temporarily the job until you will see a Peyronies specialist and make an ultrasound. You have seen a lot of urologists, non is Peyronies expert in my opinion.
Regarding surgical intervention, I really don't know and nobody can advise you in the subject except a Peyronies specialist.
I suppose the money you spent already on all the doctors will equal the expenses to visit a leading Peyronies specialist.

James

[Orome]

I have a Doppler ultrasound scheduled for next week.  It's with the same doctor that prescribed the pentox.  Hopefully I'll get some more answers then.  

[Pfract]

Quote changed by moderator - James
Please read the forum rules!!!
Hi. I also had a similar injury in my penis a few months ago. Sharp pain, although i didn't lost my erection. Had an hematoma 12h later. Due to the poor diagnosis at the ER, i am now suffering with moderate E.D. from the trauma. From everything i read on PUBMED regarding penile injuries, "sharp pain in the penis accompanied with loss of erection straight away" is a penile fracture and should have been checked out in the E.R....  And yes, there are "several degrees"