Spinning Into Surgery: A Case of Penile Fracture Due to High-Risk Sexual Activity

Penile fracture is a rare but significant urological emergency characterized by rupture of the tunica albuginea of the erect penis, which commonly occurs during vigorous sexual activity. While typical causes vary geographically, sexual intercourse and forceful penile manipulation are the leading etiologies in Western and Eastern countries, respectively. Pornography consumption has been associated with engagement in high-risk sexual behaviors and positions, potentially increasing the risk of injury. A 54-year-old man presented with acute penile pain, detumescence, and swelling following sexual intercourse in an unconventional position inspired by online pornography, colloquially referred to as the "helicopter" position. Physical examination revealed significant ecchymosis and a palpable defect on the ventral side of the penile shaft. Penile duplex ultrasound confirmed a fracture of the tunica albuginea in the proximal third of the penis, associated with an 8.5 mL hematoma and apparent involvement of a branch of the dorsal penile artery. The patient underwent prompt surgical repair, including hematoma evacuation and primary closure of the tunica defect. At the two-year follow-up, the patient was contacted and evaluated, with no evidence of erectile dysfunction or postoperative complications. This case highlights the role of pornography in promoting risky sexual behaviors, which may contribute to penile trauma in men. Surgical management remains the gold standard for penile fractures, offering favorable functional and cosmetic outcomes when performed promptly. Awareness of the potential risks of unconventional sexual positions and the impact of problematic pornography use is crucial for prevention. Penile fractures require immediate clinical attention to prevent long-term complications. This case underscores the need for public education on safe sexual practices, particularly in the context of increasing exposure to risky behaviors through pornography.