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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > Hematoma
Expert: Arthur Goldstein, M.D.
Date: 9/23/2008
Subject: Hematoma
Question
From Carsonville:
Dr. Goldstein, let me start by saying that I really respect your opinion, expertise and approach to your online "patients" from reading your many responses to others. You are truly an invaluable resource.
I know this may sound absurd and impossible, but I recently (3 weeks ago) injured my penis from prolonged masturbation. After this one particular incident, possibly accentuated by daily (a couple of days) prolonged masturbation and a fatigued/traumatized penis, my penis is now in a hard flaccid state. Sometimes it is slightly cold to the touch although during the first couple of days it was warm due to slight swelling i guess. Also, there is markedly less sensation than there was before. When I sit down the flaccid is not AS turgid, but when I stand up it gets hard again after a short period. I have not masturbated or had sex since this incident in hopes that leaving my penis alone will allow it to heal. The firm flaccid condition has improved slightly and I mean slightly over this 3 week period and some sensation has returned. (As a slightly relevant sidenote: I eat extremely healthy no sugars, avoid saturated fats, have been drinking natural juices rich in antioxidants and flavones, taking supplements such as acetyl-Lcarnitine, zinc, vitamin C along with a multi vitamin. I also take milk thistle as I've read of it's ability to prevent fibrosis in the liver and am hoping these affects might help prevent the development of fibrosis in the penis - a little hokey i know).
My initial worries and ideas of fibrosis and scarring in the penis are kind of changing focus. I'm beginning to believe that I possibly have some sort of hematoma throughout the penile cavities. Bare with me please. I know we typically think of hematoma as due to abrupt blunt trauma, but I knew a woman who had a hematoma in her uterus from giving birth to a very large baby (ie. high intensity pressure over a long period of time). This particular hematoma took 6 months to heal completely. Do you think it is possible that the hard flaccid is caused by some form of hematoma? I cannot see if there is any bruising to the internal tissues as the skin of my penis is rather dark. However, the way a balloon's walls blow up with evenly distributed pressure, do you think it is theoretically possible that I have some sort of hematoma along the walls of my inner penile cavities?
I haven't checked my erection quality for the reasons mentioned above. Although I have had morning and night erections albeit they are not long and hard but rather short,fat, and rubbery (strangely much fatter than anything I was used to). One morning I reached down there and thought OH WHAT? THAT'S NOT MINE! Anyway, I'm hopeful that continued rest will allow this to heal. One urologist told me that "Although we like to think the penis is special it's not. It is just like other parts of the body and capable of doing some serious healing on its own." Would you agree with this statement? To what extent? Obviously it can't heal artheriosclerosis and what not.
In relation, can not ejaculating for long periods because I'm resting my penis, cause problems with my prostate?
Kind of unrelated although I have SLIGHT concerns of venous leakage:
If I recall correctly, I've read a post where either you or Dr. Leslie said venous leakage surgery has a small long term success rate and I've heard this elsewhere as well. I found a 2002 study
Penile venous anatomy: application to surgery for erectile disturbance
Geng-Long HSU, Cheng-hsing HSIEH, Hsien-Sheng WEN, Tzu-Jan KANG, Han-Sun CHIANG1
Department of Urology, Taiwan Adventist Hospital, Po-Jen General Hospital, Taipei
1Taipei Medical University Hospital, Taipei
Asian J Androl 2002 Mar; 4: 61-66
http://www.asiaandro.com/1008-682X/4/61.htm
Have you seen this study or heard of any similar developments and does this research study seem valid, promising at a cursory inspection?
Answer
Terry, as you might imagine, for this type of problem it is not possible for me to make an exact diagnosis over the internet because of the inability to do a physical examination. However, I shall try to help you.
I suspect that initially you suffered either self induced trauma to the corpora or a mild form of priapism. In my experience, the former invariably heals on its own over time. In the interim, you are wise in not abusing the penis further. If you abstain totally from all sexually activity, there is the risk of developing prostatitis as even unintended sexual excitation (dreams, fantasies, touch, etc.) causes the production of prostatic fluid. It is healthy for the prostate to ejaculate periodically and in moderation (perhaps 1-2 times a week). To protect the penis, however, i would do so only by masturbation (as opposed to sexual intercourse which can sometimes become "too rough" in the heat of the moment). The use of a good quality lubricant such as one of the "silk lubricants" should help to reduce potential trauma.
Priapism can also heal on its own. However, it is more ideal to treat this in the first 48 hours. As you are now 3 weeks out, one has to rely more on "tincture of time". The urologist who examined you should have been able to shed more light on this possibility.
The symptoms you describe do not sound like venous leak;. To follow is a "macro" I have written on this condition that you may have read before. Good luck.
The penis is composed of three cylindrical bodies called corpora. The single corpus spongiosum contains the urinary canal (urethra) and the paired corpora cavernosa are the erectile bodies. The latter each contain an artery that supplies blood and they are surrounded by an elastic membrane. The corpora cavernosa contain vascular spaces that have the ability to expand with the inflow of arterial blood. The act of having an erection is dependent on many factors. In its most basic form, however, sexual arousal (touch, thought, dreams, etc.) stimulate the nervous system to send information to the penis. This causes the vascular resistance in the corpora to decrease allowing arterial blood to flow in much easier. Simultaneously, the outer elastic membrane stretches to accommodate the increased blood in the penis and an erection occurs. While arterial blood is flowing into the penis, the veins of the penis tend to let the blood escape back into the circulation. Normally, the pressure inside the corpora increases to a critical level, the corpora swells and passively compresses the veins, thus shutting off the outflow temporarily. However, abnormal venous drainage can be present either congenitally or develop spontaneously over time. In such a case, the blood may flow out of the penis too fast during attempted erection resulting in no or only partial tumescence. This is called a “venous leak”.
The venous leak can be identified by performing a penile duplex color ultrasound or by a special x-ray of the the penis called a corpous cavernosogram. The latter is an invasive test and not usually performed unless one is considering surgical repair. Although the later is an option, the success rate is disappointing. The simplest therapy is to use a thick expandable device called a confidence ring. These come in various diameters and strengths. They help to compress the veins but do not affect the arterial inflow. The ring is stretched and placed over the penis to its base just before attempting sex. They should not be left on for more than 30 minutes because of potential comprise of blood flow. Another option, is the use of medication to allow blood to more easily flow into the corpora. These agents are oral medications in the class of PDE5 inhibitors (ie Viagra, Levitra, and Cialis), penile injections (ie Edex, Caverject), and urethral suppositories (Muse). They may be successful alone or combined with a confidence ring.
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