Postcoital penile injury: Torn frenulum in an 18-year-old male

Dear Editor,

We present the case of an 18-year-old unmarried male who sustained a painful penile injury following his first unprotected vaginal intercourse. During vigorous sexual activity, he experienced a sudden sharp pain accompanied by active bleeding from the frenulum. He reported immediate discomfort but denied dysuria, urinary retention, or significant swelling.[1]

On clinical examination, a linear laceration was observed along the frenulum with mild oozing of blood, consistent with a traumatic frenulum tear [Figure 1].[2] Benign pearly penile papules were noted along the coronal sulcus, an incidental finding requiring no intervention. No evidence of infection, urethral injury, significant hematoma, or penile fracture was present. Given the self-limited nature of bleeding, he was managed conservatively with local wound care, analgesia, and hygiene measures.[3] The patient was counseled on sexual abstinence until complete healing and informed about the potential for recurrence, scarring, or frenulum breve-related complications.[3]

Figure 1.

Torn frenulum marked by a circle with fresh bleeding. Surrounding tissue is mildly erythematous without hematoma or infection. Benign pearly papules visible along coronal sulcus

Traumatic frenulum tears are relatively common but underreported in clinical practice, particularly in young males during their initial sexual experiences or vigorous intercourse.[4] The frenulum of the penis is a thin, highly vascular band of tissue connecting the prepuce to the ventral glans, contributing to penile sensitivity and mobility. Individuals with a short or tight frenulum (frenulum breve) are particularly predisposed to tearing during intercourse, leading to discomfort, anxiety, and, in some cases, avoidance of future sexual activity.[4]

Although large-scale epidemiological data on frenulum tears in India are scarce, anecdotal evidence and clinical experience suggest a significant number of such cases go unreported due to embarrassment, lack of awareness, or fear of stigmatization.[5] While minor frenulum tears heal with conservative management, larger or recurrent injuries may necessitate hemostatic measures, suture repair, or surgical procedures such as frenuloplasty to prevent complications and restore function.[5] Failure to address recurrent tears may lead to fibrosis, persistent dyspareunia, or sexual dysfunction, impacting quality of life and mental well-being.[5]

Preventive strategies, including gradual penetration, adequate foreplay, sufficient lubrication, and early recognition of frenulum tightness, can help reduce the risk of injury.[5] Healthcare professionals must create a nonjudgmental and supportive environment for young patients presenting with postcoital penile injuries, ensuring they receive appropriate medical care, counseling, and reassurance.[5]

This case underscores the importance of recognizing postcoital penile injuries, providing appropriate management, and educating patients on preventive strategies to promote optimal healing and prevent recurrence. Given the highly sensitive nature of such cases, increasing awareness through patient education, sexual health counseling, and early surgical intervention where necessary may help improve outcomes and reduce the psychological burden associated with these injuries.

We believe this case adds to the existing literature on postcoital penile injuries and highlights the need for further epidemiological studies in the Indian context to understand the prevalence, risk factors, and optimal management strategies for such cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.