Concussions: Big Head/Little Head

Andrew Siegel MD 3/19/16

Earlier this week, Jeff Miller (N.F.L. senior VP for health and safety policy) officially acknowledged the link between football and chronic traumatic encephalopathy, the degenerative brain disease found in many former players.  In this entry, the important topic of chronic traumatic brain injuries is reviewed with a segue into chronic traumatic penis injuries.

Who Knew? The athletic “cup” provides protection to the male genitals for those participating in sports including baseball, hockey, soccer and boxing. The cup was devised years before the first protective helmet for heads was developed. This gives you some insight into men’s priorities!

Traumatic brain injuries

Concussions resulting from contact sports and their sequelae of traumatic brain injuries have emerged as a hot topic. Football, boxing, soccer, hockey, rugby, lacrosse, mixed martial arts, etc., clearly incur risks for head trauma. Years ago, it was the expectation of athletes “to grin and bear it” after violently striking their heads in pursuit of victory. (I remember well when my son played football as a youngster in the competitive state of Pennsylvania, where an ambulance waited on the sidelines ready to transport unconscious 8 to 10 year-old boys to the ER. That ambulance did not sit idle for long.)

Today, sports-induced concussions have been brought to the forefront with all of the hubbub about athletes collapsing after hitting their heads and news about former NFL players suing over brain injuries. The movie “Concussion” ushered this subject to the big screen. Fortunately, positive changes are being made, with “concussion medicine” becoming a specialty discipline and concussion protocols put into force for many organized sports at the high school and college levels.

The human brain weighs about 3 pounds, is gelatinous in consistency and contains about 100 billion neurons. Nature has given us a remarkably thick skull to protect the delicate structure within. The brain literally “floats” in fluid within the skull. When the skull accelerates or decelerates rapidly—as occurs in a direct strike—the skull movement is abruptly arrested, but the brain continues in motion, twisting and bouncing within the skull, which can result in brain micro-trauma.

538px-Concussion_mechanics.svg (Modified version of Image: Skull and brain normal human.svg by Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006)

A concussion is currently defined as a motion injury of the brain. When I was in medical school, a concussion was defined as a transient loss in consciousness, but the truth of the matter is that less than 10% of concussions involve loss of consciousness. 90% of concussions manifest with symptoms including headaches, light sensitivity, nausea, vomiting, incoordination, disorientation, and abnormally slow reflexes and thinking.

It is unusual for a single concussion to result in long-term issues, as concussions are recoverable injuries if identified and treated properly. However, multiple concussions repeated over a course of many years– commonplace occurrences among athletes participating in contact sports– leave participants susceptible to chronic traumatic brain injuries including chronic traumatic encephalopathyAlzheimer’sParkinson’s disease and other forms of dementias.

How does this relate to the penis?

Sexual intercourse–which by definition is the forceful collision of two bodies– is no less of a contact sport than any of the aforementioned athletic endeavors. In parallel with traumatic brain injuries (big head), the penis (little head) is another anatomical zone that can get banged up over time. By the time a man is in his 50’s, he has likely had sex thousands of times, and as pleasurable as sex is, in reality it can be quite a traumatic event. Between self-inflicted and partnered pounding, hammering, pummeling and other abuse through self-manipulation and penetrative intercourse, respectively, it’s a wonder that the appendage doesn’t fall off!

Acute trauma is rare, but on occasion superficial veins can rupture, resulting in penile bruising and swelling that gets patients into my office in a real hurry. Rarer and more dramatic is the fractured penis that occurs when he “zigs” and she “zags,” resulting in a forceable miss-stroke and a serious injury that requires emergency surgery (previously covered in another blog:


(The image to the side is a photo I snapped of a statue of a man with a broken penis in Alcazar Palace in Seville, Spain.)

As opposed to acute trauma, chronic trauma to the penis is a not uncommon occurrence that is most often asymptomatic for many years. Just the act of obtaining a rigid erection puts tremendous compression stress forces on the penis. The outer sheath enveloping the erectile chambers of the penis—the tunica albuginea (white tunic)—is second only to the lining of the brain—the dura mater—in terms of its being the toughest tissue in the body. It is subjected to tremendous forces when the penis is erect because of the hypertensive blood pressures within the erectile chambers, well in excess of 200 millimeters mercury at full rigidity.

The potential for micro-trauma to the white tunic increases exponentially when one inserts that erect penis into a vagina and two parties move, bump and grind, creating intense shearing stress forces on the penis.  Certain positions angulate the penis and create more potential liability for injury than others. Even gentle sex can be rough with a single act of intercourse resulting in hundreds of thrusts with significant rotational, axial and torqueing strains and stresses placed upon the erect penis with the potential for subtle buckling injuries. Repeat performance perhaps a few times a week for many decades and by the time a man is in his 50s, on a cumulative basis, traumatic penile injuries—often asymptomatic in their developmental stages—can cause scarring to the white tunic and “chronic traumatic penopathy.”

Scarring to the white tunic can be problematic, resulting in deformities of the penis during erections, including the presence of a hard lump, shortening, curvature, narrowing, a visual indentation of the penis described as an hour-glass deformity and pain with erections as well as less rigid erections.  Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse.  This is known as Peyronie’s Disease, which fortunately only occurs in about 5% of men and is a treatable condition.  This topic has previously been covered:

Bottom Line: The following relationship analogy sums it up: Chronic traumatic encephalopathy is to athletes who participate in contact sports is to concussions as is chronic traumatic penopathy is to sexually active males is to buckling trauma during intercourse.  Experts in the field of  “concussion medicine” want to spread the following advice: “Protect your brain – you only get one of them.” To this I add: “Protect your penis—you only get one of them. No matter what your game, be careful and proceed with caution!

Wishing you the best of health,

2014-04-23 20:16:29

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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.  

Pelvic Rx can be obtained at, an online store that is home to quality urology products for men and women.  Use code UROLOGY10 at check out for 10% discount. 







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