This is what happens when you break your penis

If you are a man, the last thing you want to hear when having sex is a loud crack. Why? It turns out that “boner” contains the word “bone” for a reason—and that cracking sound could indicate that you’ve entered into nightmare territory. It’s the first sign of a broken penis.

Yes, broken penises are real—and they require serious medical attention. In fact, when seeking treatment, just a few hours could determine whether a man experiences a full recovery or a lifetime of complications. So how do you know you if you broke your penis? And what should you do if you suspect you have?

According to a new paper published in the journal Emergency Nurse, penile fractures require “urgent” and immediate attention. They occur from “sudden blunt force on the erect penis, usually during penetrative sex when the penis accidentally hits the perineum or the pubic symphysis.” In layman’s terms—when the penis slips out and runs into the rock solid pubic bone. Kind of like jamming the tip of your finger straight into a brick wall. Ouch.

“Penile fracture is a remarkable but under-reported urologic injury.”

Heterosexual sex is the most common cause, but not the only cause. “It is occasionally caused by aggressive masturbation, industrial accidents, turning over on a flat-surface when the penis is erect, a direct blow, or hurried dressing, for example by trapping the penis in a zip” explain the study’s authors, giving new relevance to that scene in There’s Something About Mary.

So what exactly happens to the penis when one of these godawful events occurs?

Basically, the connective tissue that surrounds the erectile tissue (or tunica albuginea) ruptures. Since that tissue is stretched during an erection, the “abrupt blunt injury or sudden sideways force on the erect penis can fracture the significantly thinned out and rigid tunica albuginea,” explain the authors. Imagine stretching a thick rubber tube as far as it can go—then snapping it.

A man’s urethra can also be injured in the process.

When a penis “breaks,” it makes a “popping, cracking or snapping” sound, followed by loss of erection and excruciating pain. Then, the penis will likely become abnormally curved—sort of like an “S” or a dead snake—and turn dark purple. The condition is called “eggplant deformity” or “aubergine sign.” The researchers included a picture of an actual patient in their paper, and let me tell you, it definitely looks like a terrifying eggplant that will haunt my nightmares forever. Here’s the actual vegetable, to give you an idea without freaking you out.

This, of course, is when time becomes critical. Guys, if you suspect you’ve broken your penis, you should not wait around to see if something is really wrong—you should get yourself to the hospital as quickly as humanly possible. The authors note that medical staff shouldn’t even spend too much time examining patients with this injury, so as not to “delay surgical intervention.”

Yes, a fractured penis usually requires surgery (which—brace yourself—can include “degloving” the penile skin) in order to prevent future erectile disfunction, permanent curvature, and pain during sex, and to repair the urethra if it’s torn.

Studies have shown that the number of hours between injury and surgery greatly impacts the future functionality of the penis. This critical window can be problematic, since some men wait to see if it gets better, not understanding the gravity of the situation.

For example, a study released earlier this year looked at 140 cases of penile fracture from 1996 to 2013 and found that delaying surgery more than 8.23 hours from the time the patient arrived in the hospital greatly increased the chance of postoperative erectile disfunction. Another study found that patients who waited more than 48 hours to get treatment reported pain during intercourse a year after recovery, as well as penile curvature.

While the jury is out on how common this injury is, doctors point out that the number of cases they’re seeing suggests it happens more often than we might think.

A case study report from India, published in 2013, noted that three males came into a hospital with penis fracture within a span of 10 days. “All of them with the typical history of injury to the erect penis when it slipped out of vagina during intercourse and hit against the female perineum,” stated the report. One of the men, aged 77, had waited over 60 hours to seek treatment.

Another paper commented that “Penile fracture is a remarkable but under-reported urologic injury,” noting that “The true incidence of penile fracture is not known even in western countries because it is under reported or hidden probably because of social embarrassment and sociocultural characteristics, even if it is reported to physicians it remains undiagnosed or mismanaged.” That particular paper looked at 52 patients with penis fractures, half of which were 16 to 30 years old.

Another study suggests that penile fracture may be more likely to occur during stressful sex. Researchers from the University of Maryland reviewed the cases of 16 patients who fractured their penis and found that half of the patients were injured while having an extramarital affair—and all but three patients were having sex in out-of-the-ordinary places such as cars, elevators, the workplace, or public restrooms.

Another study found that “woman on top” (either traditional or reverse cowgirl) was more likely to cause penis breakage than any other sex position during heterosexual sex. The researchers note that “when a woman is on top she usually controls the movement with her entire body weight landing on the erect penis,” and the man can’t prevent it from happening. In the Middle East, most cases of penis fractures—according to the same study—are due to “manual bending of the erected penis.” In other words, men trying to hide an erect penis under clothing.

So what have we learned? For one, many things can break your penis—crazy sex, vigorous masturbation, bending it in ways it should not bend, and more. And second, if it happens to you, seek medical attention immediately, no matter how embarrassing the circumstances.

Your penis will thank you.

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.