Love is a battlefield with wounds, scars, and for one man — a penile fracture. A 2014 case report (extremely NSFW) released Thursday by The New England Journal of Medicine reports that a 42-year-old Boston man was rushed to the emergency room after breaking his penis during aggressive sex. The bedroom freak incident occurred when the man’s penis accidentally hit the woman’s perineum — the space between the vagina and the anus.

"He heard a snap, noticed a rush of blood from the meatus, had immediate detumescence, and had severe pain," wrote Dr. Robert J. Hartman, an urologist at Brigham and Women's Hospital in Boston. "On the basis of the clinical presentation, the patient was taken to the operating room for emergency repair. The patient had an uneventful postoperative course and was discharged from the hospital the morning after surgery."

The man suffered a penile fracture, also known as broken penis syndrome, meaning he broke the outer tissue of his penis, or the tunica albuginea, which surrounds the corpora cavernosa — the spongy tissue in the core of the penis that fills up with blood during an erection. When the tunica albuginea tears, says the National Institutes of Health, the blood confined in this region leaks out into other tissues, leading to bruising and swelling. Upon hearing the penis snap, the man claimed blood was forced out of his body through his urethra, which is why he saw blood coming out from the tip of his penis.

Commonly with penile fractures, doctors place patients under general anesthesia and open up the skin with one or more incisions in the penis. "We then pull that skin all the way back to the base of the penis, exposing the erectile cylinders of the penis, as well as the urethra. This allows us to easily identify the injury — 'the crack' — in the cylinder and close it with stitches,” Hartman told The Huffington Post.

Typically, consequences of penile fractures include erectile dysfunction, the formation of fibrous plaques — scar tissue forming in the penis — a curve or bend of the penis, and damage to the nerves in the genitals. After follow-up appointments at three and six months, the patient has the ability to maintain a full erection. For the man in this case, there was no noticeable curvature or plaque on his penis.

In January, a study published in the journal Advances in Urology found most penile fractures in the West occur in the female-on-top, or “reverse cowgirl,” position. In the Middle East, particularly in Iran, approximately half of all penile fractures were due to men forcibly hiding their erections. Penile fractures remain as one of the most common sex injuries among young men in their 20s and 30s who tend to engage in more vigorous sex, although it is seen with men in their 40s and 50s, like in the case report.

Source: Hartman RJ. Penile fracture. New England Journal of Medicine. 2015.