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What may be every man's worst medical nightmare happened to 32-year-old Ross Asdourian.
"I think that all men in the depths of their brain know that this is possible. And I will go a step further and say that most men have probably had scares where maybe it bent a little bit, myself included," Asdourian said.
About three years ago, Asdourian, a New York-based comedian and filmmaker, met up with an old friend at a bar. He took her back to his apartment in Manhattan's East Village.
"We were basically approaching the finish line … and I came out, and when I went to go back in, she was pushing back, and basically it just popped," he said.
Asdourian suffered a severe case of penile fracture — what in medical terms would be referred to as a "corpus cavernosa rupture," according to Dr. Jack Mydlo, professor and chair of urologic surgery at Temple University, who was not involved in Asdourian's case.
" 'Penile fracture' is a common term, but when people hear penile fracture, they think of a bone in the penis, and there's no bone in the penis, I can assure you. It's more of a rupture," Mydlo said.
The corpus cavernosa is a pair of sponge-like tissues that runs along the length of the penis. Along with the corpus spongiosum, which surrounds the urethra, the corpus cavernosa expand with blood when a man is aroused, according to Dr. Rajveer Purohit, director of reconstructive urology at Mount Sinai Hospital in New York and the primary surgeon in Asdourian's case.
"It's a unique tissue that's only present in the penis," Purohit said. "When you get an erection, blood flows into the corpus cavernosa, and it fills up like a sponge."
But when too much pressure is placed on the tissue, the external envelope surrounding the corpus cavernosa — called the tunica albuginea — can tear, causing a corporal rupture, according to Purohit.
"You can imagine a balloon that gets filled up with water, and then you have this tense sheath that's surrounding the balloon, and that's what gives you the stiffness with an erection. And the fracture is a rupture of the balloon and the sheath surrounding the balloon," Purohit said.
"The vast majority of cases are one-sided, or unilateral, corporal ruptures. But sometimes you do have someone who's had a bilateral, or two-sided, corporal fracture involving the urethra" as Asdourian did, Mydlo said. "But that's rare. You have to have major, major trauma for that to happen."
As soon as he heard the "pop," Asdourian says, he knew that one of his greatest fears had been confirmed.
"I knew right away that something was wrong, and I went straight into emergency protocol. I breathed in the pain for a couple of beats, rolled over, flipped on the lights and called 911," he said.
Penile fractures are relatively rare, but due to the sensitive nature of the condition, they are probably more common than many people realize, according to Mydlo.
Through his two medical practices in New York and Philadelphia, Mydlo says, he sees one or two cases of penile fracture every month.
"Those are two major population complexes, so you're going to see a lot [of cases] just by the sheer size of the population you're dealing with," he said.
"The sad thing is that patients are usually embarrassed to go to the doctor or the emergency room," Mydlo said. "Usually, these guys are young people, and they have their whole lives ahead of them. Why should they suffer in silence? This should be no embarrassment. It happens. Let's just fix it."
A 2002 study identified more than 1,300 cases of penile fractures in the medical literature since 1935. According to the study, over half of these cases were from predominantly Muslim countries, where men sometimes take drastic measures to hide their arousal. "In other countries … particularly in the Middle East … people try to lose their erection because they're socially embarrassed about it," Purohit said. Such efforts to forcibly subdue an erection can result in its fracture.
In the US, the majority of cases are due to traumatic coitus and are usually caused by thrusting against the pubic symphysis or perineum. Certain positions, such as having the partner on top, are also higher risk, according to a 2004 study.
After the ambulance arrived, Asdourian was taken to Weill Cornell Medical Center, where he was quickly seen by a team of urologists.
"Dr. Wang, whose name is real, first performed a cystoscopy on me," Asdourian said. "And the first big test was to see if I could pee in a jug — and I couldn't. And if you can't pee, then there's a ticking time bomb on what they're going to do."
A cystoscopy refers to a procedure in which a camera is inserted into the penis to assess the urethra and bladder. It is commonly used to evaluate for stones in the urinary tract; blood in the urine; loss of bladder control; or trauma to the urethra, prostate or bladder, according to the Mayo Clinic.
The cystoscopy confirmed that Asdourian had torn his urethra — a medical emergency, according to Purohit.
"Ross actually had a not-so-common fracture of both corpora cavernosa as well as a complete disruption of the urethra," Purohit said.
"If you don't repair the urethra, you can get scar tissue that would prevent them from urinating normally, or a fistula forms where the urine would have just been pooling outside the urethra," Purohit added. "So the sooner they go to the hospital, the better."
The next morning, Asdourian underwent a three-hour surgery to repair his injury, according to Purohit. "I did a urethroplasty, where we cleaned up the edges of the urethra and then put the two edges back together," Purohit said.
After four weeks of recovery, Asdourian was able to urinate on his own. After a few months, he had regained full sexual functioning, he said.
"Ross preserved his erections, so he's doing well with that, and his urine flow is completely normal — so basically, he had no negative outcomes," according to Purohit.
Asdourian has since written a book about his experience, "Broken Bananah," available on Amazon starting Wednesday.
"I hope that (the book) reaches people and it makes people laugh, and in a time when people are having a tough time laughing, I think that this is something that we can all laugh about," he said.
"I think everyone has a story to tell and this just happened to be mine," Asdourian said. "I think when we're faced with our sexuality, it puts a lot of things into question."
Ultimately, Asdourian says, he learned a valuable lesson through his experience: "It can always be worse. Even when we lose our core family jewels, it truly can always be worse. And that's a good perspective to have, because we're just a blip on the radar, and there are miracles happening every day."