Avulsion of the male external genitalia is not always accompanied by serious consequences, and even in some cases the sexual power is preserved. Knoll described a case in 1781, occurring in a peasant of thirty-six who fell from a horse under the wheels of a carriage. He was first caught in the revolving wheels by his apron, which drew him up until his breeches were entangled, and finally his genitals were torn off. Not feeling much pain at the time, he mounted his horse and went to his house. On examination it was found that the injury was accompanied with considerable hemorrhage. The wound extended from the superior part of the pubes almost to the anus; the canal of the urethra was torn away, and the penis up to the neck of the bladder. There was no vestige of either the right scrotum or testicle. The left testicle was hanging by its cord, enveloped in its tunica vaginalis. The cord was swollen and resembled a penis stripped of its integument. The prostate was considerably contused. After two months of suffering the patient recovered, being able to evacuate his urine through a fistulous opening that had formed. In ten weeks cicatrization was perfect. In his "Memoirs of the Campaign of 1811," Larrey describes a soldier who, while standing with his legs apart, was struck from behind by a bullet. The margin of the sphincter and, the skin of the perineum, the bulbous portion of the urethra, some of the skin of the scrotum, and the right testicle were destroyed. The spermatic cord was divided close to the skin, and the skin of the penis and prepuce was torn. The soldier was left as dead on the field, but after four months' treatment he recovered.
Madden mentions a man of fifty who fell under the feet of a pair of horses, and suffered avulsion of the testicles through the scrotum. The organs were mangled, the spermatic cord was torn and hung over the anus, and the penis was lacerated from the frenum down. The man lost his testicles, but otherwise completely recovered. Brugh reports an instance of injury to the genitalia in a boy of eighteen who was caught in a threshing-machine. The skin of the penis and scrotum, and the tissue from the pubes and inguinal region were torn from the body. Cicatrization and recovery were complete. Brigham cites an analogous case in a youth of seventeen who was similarly caught in threshing machinery. The skin of the penis and the scrotum was entirely torn away; both sphincters of the anus were lacerated, and the perineum was divested of its skin for a space 2 1/2 inches wide.
Recovery ensued, leaving a penis which measured, when flaccid, three inches long and 1 1/2 inches in diameter.
There is a case reported of a man who had his testicles caught in machinery while ginning cotton. The skin of the penis was stripped off to its root, the scrotum torn off from its base, and the testicles were contused and lacerated, and yet good recovery ensued. A peculiarity of this case was the persistent erection of the penis when cold was not applied.
Gibbs mentions a case in which the entire scrotum and the perineum, together with an entire testicle and its cord attached, and nearly all the integument of the penis were torn off, yet the patient recovered with preservation of sexual powers. The patient was a negro of twenty-two who, while adjusting a belt, had his coat (closely buttoned) caught in the shafting, and his clothes and external genitals torn off. On examination it was found that the whole scrotum was wrenched off, and also the skin and cellular tissue, from 2 1/2 inches above the spine of the pubes down to the edge of the sphincter ani, including all the breadth of the perineum, together with the left testicle with five inches of its cord attached, and all the integument and cellular covering of the penis except a rim nearly half an inch wide at the extremity and continuous with the mucous membrane of the prepuce. The right testicle was hanging by its denuded cord, and was apparently covered only by the tunica vaginalis as high up as the abdominal ring, where the elastic feeling of the intestines was distinctly perceptible. There was not more than half an ounce of blood lost. The raw surface was dressed, the gap in the perineum brought together, and the patient made complete recovery, with preservation of his sexual powers. Other cases of injuries to the external genital organs (self-inflicted) will be found in the next chapter.
The preservation of the sexual power after injuries of this kind is not uncommon. There is a case reported of a man whose testicles were completely torn away, and the perineal urethra so much injured that micturition took place through the wound. After a tedious process the wound healed and the man was discharged, but he returned in ten days with gonorrhea, stating that he had neither lost sexual desire nor power of satisfaction. Robbins mentions a man of thirty-eight who, in 1874, had his left testicle removed. In the following year his right testicle became affected and was also removed. The patient stated that since the removal of the second gland he had regular sexual desire and coitus, apparently not differing from that in which he indulged before castration. For a few months previous to the time of report the cord on the left side, which had not been completely extirpated, became extremely painful and was also removed.
