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A consultant urologist at the Urology Unit of the Korle Bu Teaching hospital, Dr J. E Mensah, has attributed the increasing rate of penile fracture (injury in penis during erection) to the aggressiveness with which couples, especially the young, approach sex. He said the most common cause of such cases reported at the unit was linked to �aggressive� sexual skills and the partner�s effort to impress each other. He advised that sexual positions where the female partner is on top, or where there is extreme bending or side to side motion, should be approached with caution. �Any rigorous sharp bend can break the penis and this can lead to impotence or erectile dysfunction if it is not reported immediately,� he said. Penile Fracture Penile fracture is a relatively uncommon condition that is caused by the tearing of a membrane (corpus carvernosum and or the corpus spongiosum) of an erected penis. It is usually accompanied by a loud popping or cracking sound, as well as the sudden onset of severe pain. Loss of erection, bruising and swelling of the membrane may also occur. Treatment According to Dr Mensah, penile fracture is a clinical diagnosis and immediate surgical repair offers complete recovery of sexual function and added that so far, the unit had conducted successful surgeries with the patients recovering fully. He explained that the condition is a medical emergency and men who experienced any of the symptoms or any severe pain of the penis should seek immediate treatment. �Though we undertake series of surgeries every year, the true incidence is not known but is perhaps much higher than reported because many patients do not seek medical attention due to embarrassment or fear. A lot of people are shy to report to the hospital with such cases so they do self-medication or talk to unqualified people who administer different medications which could worsen the situation,� he explained. He explained that some men also attributed the situation to spiritual causes and so sought advice from spiritualists. �There is nothing spiritual about penile fracture; it is a complete medical situation so it is best to report to a medical officer for treatment. After the treatment, patients are given a period to abstain from sex and once the injury heals fully, they can be sexually active again.� Risk of leaving a penile fracture untreated Tearing of the tunica albuginea (the tough fibrous layer of connective tissue that surrounds the corpora cavernosa of the penis) that is left untreated may result in the scarring of the tissue underlying the skin of the penis. This can lead to impotence, erectile dysfunction, as well as bending of penis during erection. This condition, which is known as Peyronie�s disease, can cause severe discomfort during sex or make penetration impossible and corrective surgery will be required to treat the condition once it has progressed to this point. Who is at risk of penile injury? Dr Mensah explained that although penile fractures are commonly seen in younger men who tend to engage in more assertive acts of intercourse and who generally have more rigid erections, men in their 50s and beyond may experience injuries to the penis too. He said men who also engaged in masturbation also faced a high risk of getting the fracture.