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June 13, 2020

Pain in the Penis: Tales From the Emergency Room with Dr. Seth Brener and our Dr. Yang

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Donna Lee: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee. Dr. Mistry stepped away, so we have our partner, Dr. Christopher Yang, here. Welcome.

Dr. Yang: 

Hey. Happy to be here again.

Donna Lee: 

Thanks for coming in. I know it’s a busy Saturday, so I wanted to get right to it. We have a super special guest that you’re going to be able to listen to you on our podcast wherever you listen to podcasts for free, and you can send them questions to armormenshealth@gmail.com. But let’s get right into it, because we have some fun stuff to talk about with Dr. Brenner, who is an ER doc.

Dr. Brenner: 

Hey guys. Thanks for having me.

Donna Lee: 

I know Dr. Yang’s got a huge list of things we can talk about.

Dr. Yang: 

Yeah. Yeah. Thanks. Thanks for coming back to the show. So you’re an ER doc here in Austin, right?

Dr. Brenner: 

True story.

Dr. Yang: 

Right. And you also work somewhere else.

Dr. Brenner: 

Part-time in Los Angeles and East LA.

Donna Lee: 

Oh, that’s right. Your brother is an actor.

Dr. Brenner: 

Correct, true. Also a true story.

Donna Lee: 

He was on a show recently?

Dr. Brenner: 

Most recently Silicon Valley. He was, he’s a solid star and he lets me crash in his extra bedroom when I’m in Los Angeles.

Donna Lee: 

That.

Dr. Yang: 

So there.

Dr. Brenner: 

Burgeoning career here.

Dr. Yang: 

All right. So are people crazier? Do you see crazier stuff in Los Angeles or here in Austin?

Dr. Brenner: 

After practically a decade in the game here, I can tell you, it does not matter where you go, where I’ve worked, what hospital…nothing ever surprises me more than the things people do with their human body.

Donna Lee: 

Oh, but do surprise us.

Dr. Brenner: 

It’s the best. It’s the best though. It…

Donna Lee: 

What’s your top favorites? Like…

Dr. Brenner: 

You’ve got to love the foreign bodies, you’ve got to love the sex stories, you’ve got to love. I mean, and then just the ones that you cannot even imagine this really happened. Those are the ones where you’re like, “You chose to make this decision with your life.”

Dr. Yang: 

Alright, so to keep it maybe on a men’s health theme…

Donna Lee: 

Oh yeah, forgot.

Dr. Yang: 

…what are some foreign bodies that you’ve seen and what should people put in their body or not put in?

Dr. Brenner: 

Okay. So for the most part, the meatus, the entry point of the, of the male urethra is 100% an exit and should be treated as such. The classic thing we see is a lot of times it’s a psych patient who is exploring and jabbing things into their meatus, and it is not fun. Now, a lot of times there’s an S & M component to this, and this is people who thrive and get off on pain. The most common thing we see is usually a cotton swab and someone either, maybe they’ll have a herpes outbreak and they’re applying topical medication in the cotton swab tip will get in. And then there’s always a little tiny bit of urine at the entry point of the meatus. As soon as the cotton ball gets in there, it’ll expand, and then you are in just agony, just a world of hurt.

Dr. Yang: 

Then you are stopped up.

Dr. Brenner: 

You are quite literally stopped up.

Donna Lee: 

So we’ve seen some of that, too, Dr. Yang. You did some ER stuff.

Dr. Yang: 

Yeah. Typically I get called when there’s, you know, things that are put in that friendly neighborhood ER doc can’t pull out by themselves.

Dr. Brenner: 

…and does not want to pull out by themselves.

Dr. Yang: 

Yeah, yeah, that’s probably true, too.

Donna Lee: 

Are you trying to say that you just don’t want to do it sometimes, so you call Dr. Yang?

Dr. Brenner: 

I’m happy to do it. We’re happy to do it. It’s, it typically becomes if we can’t do it, we got to call in the pros.

Dr. Yang: 

Yeah. Sometimes, you know, I’ve seen pens, I’ve seen…

Donna Lee: 

…glass rods.

Dr. Yang: 

Yeah, rods. There’s been bits of cardboard. I’ve seen some fish hooks that were pretty tough.

Dr. Brenner: 

That sounds fantastic.

Dr. Yang: 

They were barbless but that was…

Dr. Brenner: 

That’s beside the point.

Donna Lee: 

And that’s a no, no. Guys, listen, that’s a no no.

Dr. Brenner: 

I had a psych patient put a pencil eraser…that, actually that one wasn’t too bad to get out. That was fine. And then there’s chronically a case of drug seeking patients who are addicted to narcotics and they’re doing whatever they can faking whatever injury they can, but sometimes will do real injuries. There’s this one patient who will insert whatever foreign object he can to start bleeding, to cause active bleeding when the blood mixes with the urine, it makes it look like high volume blood loss, and he’ll come in screaming in agony, and he’ll literally be urinating blood, you know, decent volume of it and, to get his Morphine or Dilaudid or Fentanyl and every now and then these guys will fool you, you feel terrible for that.

Donna Lee: 

Don’t you feel violated when they come back?

Dr. Brenner: 

Everything about you just feels wrong.

Dr. Yang: 

Yeah. So, you know, if there’s something big in there and typically we need to chase it with something, a bigger instrument to get it out. So, you know, anyone out there who’s thinking about putting something in your urethra…

Donna Lee: 

Don’t.

Dr. Yang: 

…what would you say to them doctor?

Dr. Brenner: 

I would say, I would say, “Take a minute to catch your breath…”

Donna Lee: 

“Think it through.”

Dr. Brenner: 

…”and just say no.”

Donna Lee: 

Think about how it’s going to go in the ER when you have to have it removed. That’s what they should think.

Dr. Brenner: 

Right. It’s…And plus, do you really want to go home and tell your friends, your wives or girlfriends, “Guess where I just was and what I was there for?”

Donna Lee: 

How do you explain that to the family at dinner?

Dr. Brenner: 

Yeah.

Donna Lee: 

What about tattoos and piercings?

Dr. Brenner: 

So fair bit of this has become popular in the last 10, 15, 20 years. I would strongly advise avoiding this, just because the rate of infection is so high and this becomes a whole nother topic of conversation there. It just, like any other part of the body, the penis, the scrotum will get infected. If you start adding foreign bodies, even if applied in a quote unquote “sterile manner,” you increase the risk of infection. The common Prince Albert, there’s also piercing through the meatus, through the head of the penis, and if it gets infected, I mean, my God, you’re in a world of pain, a world trouble, and you could potentially lose the whole phallus.

Dr. Yang: 

Yeah, yeah. Basically, that’s, you know, that’s something dangling on a part of your body that…

Donna Lee: 

…that’s dangling.

Dr. Yang: 

Yeah.

Dr. Brenner: 

Touche.

Dr. Yang: 

…and that has a lot of, you know, potential friction, you know, during intercourse. I’ve definitely seen it where, you know, piercings get caught and it can tear out, it can tear bits of your tissue off. So yeah, I definitely would not recommend that.

Dr. Brenner: 

Even though it looks really cool, but yeah…

Donna Lee: 

Does it? Does it really? It looks like a giant wrestle, the one-eyed muscle with the piercing. That’s not, not pleasant. What else can we talk about in the ER that’s fun?

Dr. Brenner: 

What can’t we talk about in the ER that’s fun?

Dr. Yang: 

Well, I guess another thing that we see sometimes is a penile fracture.

Donna Lee: 

Oh, that’s right.

Dr. Brenner: 

So this is the classic and this is one of my favorite injuries.

Dr. Yang: 

Personal?

Donna Lee: 

You should be in urology.

Dr. Brenner: 

Yes, not personal. But without question people come in and either they are completely embarrassed and just shy and they’re gonna lie through their teeth or they’re gonna just straight up own it. And that almost certainly this happens with an erect penis during vigorous sexual activity.

Donna Lee: 

And reverse cowgirl.

Dr. Brenner: 

Sure, sure.

Donna Lee: 

That’s what I learned at work.

Dr. Brenner: 

So you know, very intense sexual activity, the penis falls out of the vagina or the rectum–you know,we’re not here to judge–and it will literally fold on it over on itself completely. And it gets the term fracture despite there not being a bone, but the term is colloquial and it applies without question. The shy ones were [inaudible] always, “Doc. I fell in the shower. I slipped and fell.”

Donna Lee: 

“I fell hard in the shower.”

Dr. Brenner: 

“I was taking care of myself, and I fell in the shower…” No. Lies. Lies, lies, lies. And then the best ones are the ones, the guys that come in with their wives or their girlfriends or their boyfriends, and they’re just like, “We were going at it. This happened, all of a sudden something’s wrong.” And they know…

Donna Lee: 

WIll they hear a snap or a pop?

Dr. Yang: 

Yeah. They definitely can hear a snap, they may feel a pop. Most of the time they lose the erection right away. A lot of times you have an ecchymosis, it’s basically a hematoma where, you know, you see purple and all along the shaft of the penis, maybe down towards the scrotum, the testicles, maybe up towards the abdomen some.

Donna Lee: 

Oh boy.

Dr. Yang: 

So what it actually is, it’s a fracture, it’s not an actual fracture, like dr. Brenner said. It’s a tearing of the corpus cavernosum, which are the structures in the penis that fill up when you get an erection. It is a surgical emergency, meaning that typically what we do is we take them, we do a penile exploration and try to repair that torn area. It’s not an emergency in that it’s going to kill you, but it is something that, if it doesn’t get fixed, it definitely can lead to worsened erections in the future.

Donna Lee: 

Yeah, we had a patient recently that waited too long, and now he’s got some serious Peyronie’s. So we’re going to fix that. Dr. Yang’s going to fix that.

Dr. Yang: 

Yeah. So, bottom line, if you feel a pop during intercourse, then you probably should come into the emergency department.

Dr. Brenner: 

Yeah. Come say, hi.

Donna Lee: 

Oh boy. That sounds really intense. What else can we talk about real quick before we go to commercial? If you’re feeling like a reverse cowgirl, just don’t do it. And don’t stick things in your pee pee hole. Is that what you’re saying?

Dr. Brenner: 

Agree to disagree on the reverse cowgirl. You do you, guys and gals, whatever you’re feeling. But definitely anti inserting anything into the penis under any circumstances.

Dr. Yang: 

Well, you know, as a urologist, you know, we definitely insert things, but that’s under the care of a professional. So you amateurs at home, don’t do it. You know, if you’re going to the hospital, you know, let your doctors and nurses put in the catheter if you need to.

Donna Lee: 

Right. We had a recent patient case where the guy put in a domino, a [inaudible] of dominos. So thats a thing, we Googled it.

Dr. Brenner: 

Fantastic.

Donna Lee: 

Yeah. I’m sure you’ll see that soon, because apparently it’s a rage and trend right now.

Dr. Brenner: 

Can’t wait.

Donna Lee: 

You’re welcome. So don’t do that. I guess we’ll give you all some contact information. If you have any questions for Dr. Brenner, Dr. Yang, Dr. Mistry, anybody on our team, you can reach out to armormenshealth@gmail.com and we’ll get those questions answered. I respond to all the emails and let you know that we receive the email. You can go to our website, armormenshealth.com and please visit our podcast. You can hear all of this magic again. I’m sure that you will be able to Google strange things that happened in the ER and this podcast will probably pop up. So wherever you’re listening to podcasts, just search the Armor Men’s Health Hour.

Speaker 3: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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