Protecting Your Balls: A Guide to Genital Trauma

0:00This is an iHeart Podcast. Guaranteed human. Let's be real. Eating is a huge part of our lives. It fuels us. It brings us together. And yes, it's one of life's great pleasures. But once a meal's over, we don't think much about what happens next. Unless something starts to feel off. Introducing Eating Interrupted, a new podcast from iHeartRuby Studio, hosted by longtime journalist and Crohn's patient, Cynthia McFadden. Listen in to unpack what it means when your body doesn't always respond to food the way you expect and what science is now revealing about why. Listen to Eating Interrupted on the iHeart app, Apple Podcasts, or wherever you get your podcasts.

0:40Are you looking for support in your weight management journey? ZepBound Terzepatide may be able to help. ZepBound is a prescription medicine used with a reduced calorie diet and increased physical activity to help adults with obesity. or some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off. ZepBound is approved as a 2.5, 5, 7.5, 10, 12.5, or 15 milligram injection. ZepBound contains terzepatide and should not be used with other terzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if ZepBound is safe and effective for use in children.

1:20Don't share needles or pens or reuse needles. Don't take if allergic to it, or if you or someone in your family had medullary thyroid cancer, or if you've had multiple endocrine neoplasia syndrome type 2. Tell your doctor if you get a lump or swelling in your neck. Stop ZepBound and call your doctor if you have severe stomach pain or a serious allergic reaction. Severe side effects may include inflamed pancreas or gallbladder problems. Tell your doctor if you experience vision changes before scheduled procedures with anesthesia. If you're nursing, pregnant, plan to be, or taking birth control pills.

1:51Taking ZepBound with a sulfonylurea or insulin may cause low blood sugar. Side effects include nausea, diarrhea, and vomiting, which can cause dehydration and worsen kidney problems. Talk to your doctor. Call 1-800-545-5979 or visit zepbounds.lily.com. If you like YouTube, you'll love YouTube Premium. Hi, I'm Sean Evans from Hot Ones, and I want to tell you about YouTube Premium. It has offline downloads, so you can watch without Wi-Fi. Background play, so you can lock your phone and it still plays, baby. Oh, and it is completely ad-free. Yes, I said it, ad-free. Try YouTube Premium for two months free at youtube.com slash premium.

2:35Trial eligibility varies, terms apply, cancel anytime. You're the best field operative I've ever had. You were born for it. In 81, the embassy went down. We go 25 million in the wall. Where? Hotel Tehran. This is bad. Like run for the hills band. Do it now. I don't have the money, but I've got something more valuable. You shall know the truth. The truth? Don't make it free. The Fix, in theaters September 11th. I survived nine months in captivity, and I've spent my life exploring how other people survive what should have destroyed them. I'm Elizabeth Smart and these are The Survivor Files. Every week, I'm with survivors who live through the unthinkable, abducted, stalked, controlled, and nearly silenced.

3:31These are stories about what it takes to make it out alive. Listen to The Survivor Files with Elizabeth Smart on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

4:02Welcome back to the mail room where we nut up or shut up. Today is the day we're going to talk about when bad things happen to good genitals. I am so scared for this one. I'm sorry. This is not giving me a warm, fuzzy feeling. Your color looks perfect right now. You look good on the verts. So I don't know if you want to raise the blush on your filter just to make sure we're going to be okay. But, you know, I want to keep it current. There was an article recently, which I think was actually a very good public service announcement kind of thing, where I would say we should know about these things.

4:39And there was an article about a Sacramento A, almost Las Vegas A, so baseball player, Joshua Corita-Grauer is his name. And he went public, thankfully, I guess, just for people to understand the context with the fact that he took a foul ball up into his groin and ruptured his testicle. So this is a thing, right, that happens, testicular rupture. just to kind of give a shout out to the stoicism of men's health and why you know i started to be a men's health specialist is i always say that guys don't go to the doctor unless there's a bone sticking out of their body or their penis doesn't work and i'm gonna have to revise that now because of of joshua's event where they don't go to the doctor even if their testicle has ruptured because this guy still played the foul ball.

5:31Remember, it's a foul ball. So he still had a bat. So he winced to the ground, got up, and he got a single. He hit a base hit, ran to first base with a ruptured testicle, and then said, wait, I think this is really bad. And at that point, left the game and was diagnosed with a testicular rupture. So this guy, right, he leaves the game, goes to the hospital, and we're going to talk about what happens if you rupture a testicle or what you should worry about. This guy, though, what a great story. he hit his first major league home run early in the game too. Oh, wow. Right. So single foul ball, rusted testicle, single and home run earlier in the game and his first major league game, which is truly remarkable.

6:09And I just wonder what he's going to remember most. I was going to say it's a mixed day, a mixed day of ball stories. Yeah. It, well, it's truly a testament to what we can play through. Yeah. And, and, and, you know, just how elite athletes are so able to not feel pain the same way as us mere mortals. But yeah, I thought that is a good way to talk about trauma in general, because there are things maybe not to only prevent, but also just to recognize when you could get in trouble. And so just as a background, as a urologist specializing in men's health, I still am a specialist on any kind of general trauma.

6:48So if I'm taking call and a gunshot to the kidney or a ureter, bladder, urethra, prostate, penis, vas deferens, any of those things, testicles, obviously, then I have to jump into action and figure out what to do. But I think today we'll really just talk about the genital traumas because that's really what I specialize in. And so we'll get back to the testicle, but let's talk about the penis, right? Because we talked about the four horsemen of the pinoculips earlier and bad things happening to good penises. So I don't need to recap that because we've already done it. And I've already made you faint once a few episodes ago with penile trauma there.

7:27But just to revisit, it's a squishy organ. It's a soft tissue, fills up with blood at the drop of a hat or the drop of a needle on a Barry White record. Same thing. You just get this, boom, blood flow instantly there. and that tough membrane that used to be surrounding a squishy organ turns into this highly engorged sausage and it hits something hard like the bone of a partner, a bedpost. I've heard everything. It can snap and decompress and lose all that blood. So bottom line is remember if you didn't listen to the last episode on penile fractures and the pinocalypse, listen to it again. But also if you break your penis, if you are sitting there and you just woke up from your post-coital bliss and like most listeners are turning on my podcast, which is a great time.

8:16You know, it's better than a cigarette. It's, you know, Mills' podcast. But you, you know, maybe got a little violent with Mr. Friendly there and you snapped it. You know, come see me in the ER and we'll take care of you. So that's one. What about, this is one you should be setting down for, traumatic penile amputation, right? Are you - The Bobbitt story. Yeah, you remember, I was going to say, the Bobbitt story. I thought you would, I thought you'd be too young, but anyone old enough to remember the Bobbitt story. You never forget. For those of us that don't remember, wife traumatically amputates his penis when she discovers his rampant philandering, essentially, threw his penis out of a roadside dish on the way out of town.

8:59And that's a way to sunset and just running into the sunset, racing away, probably the sunrise. but paramedics dutifully found it and were able to to reattach it so traumatic penile amputation if you still have the organ is reattachable which i think is is super important because there are times when when this is something that has to be undertaken very quickly it's a matter of sewing nerves back together the urethra blood vessels so that guys with a good re anastomosis or putting all the the organ back together actually can still regain function as Bobbitt did and I think he even did some adult entertainment as a yes he did yeah as a testimony to the fact or as a testicular money to the fact that you can I know it doesn't work but same Latin origin by the way testify wow I know yeah I took care of a guy which is actually a tragic story this there's nothing funny I'm just gonna say take off your funny hat for a while but it was I was a resident and I was on multiple different services covering as surgical residents do we We cover neurosurgery, plastic surgery, urology on call.

10:07And a guy came in who was from a very prominent family who had severe bipolar disorder, had a schizoaffective component, decided to go off his medications. And he went on this multi-week sex bender where within the order of those weeks, just had prostitute after prostitute. And unfortunately, when he came off his manic episode, developed a psychosis with internal voices telling him that the only way out of this mess is to remove his penis. And so this side of the border didn't find any surgeon that would oblige, but somehow found a guy in Mexico that was happy to relieve him of not only his penis, but also thousands of dollars that led him into our emergency room when he came back in the United States, because unfortunately he got a terrible infection.

10:52When you have your penis amputated, you have to figure out how to urinate. Obviously, penetrative intercourse is off the table. And so he devised a urethra behind the testicles called a perineal urethrostomy. And that's how this man is going to have to pee the rest of his life unless we talk about reconstructive surgery for him. And that wound broke down. And the thing that's sad about this story is obviously this person had a diagnosed mental illness, kind of got away from his family, disappeared for a while. And now when he was back on his medication, just had this horrific regret, horrific regret where he thought, oh, my God, I can't believe I did this, which just goes to show how important mental health is.

11:36And that's really what the story is about, is making sure that if you have mental health diagnosis, stay on your medication. If you're feeling like you're in a place where you shouldn't be, then reach out, you know, reach out to your family, reach out to your doctors. The news for this gentleman is that if you have a traumatic penile amputation that can be fixed, we can develop what's called a neophallus. And we do this both in traumatic amputations. Sadly, in some war-torn countries, one of those signs of dominance is for soldiers to be kept alive, but to have their penis amputated is kind of a war bounty or a counting coup of sorts.

12:18And so this is way more common than you think, which is why we can fix it. We can reconstruct a urethra and a penis. Usually what we'll use is the inner muscles of the forearm through what's called a forearm flap or grafting that we can do so that not only will have somebody who will have a visible penis, but we can actually devise a urethra to hook up so that a man can pee through his penis's neophallus and actually even place surgical penile implants in them to provide for penetrative intercourse. And to even make it more realistic, we can actually transfer nerves to give some degree of sensation so that you can have a little bit of reasonable sexual sensation.

13:04So we do this in transmasculine men that also want to have neophallus construction so that you can have urination, penetrative intercourse, and potentially even sexual pleasure with the neophallus. So all is not lost with this. But traumatic penile amputation is something we just don't hear a lot about.

13:34Let's be real. Eating is a huge part of our lives. It fuels us, it brings us together, and yes, it's one of life's great pleasures. But once a meal's over, we don't think much about what happens next, unless something starts to feel off. Because what we eat and how our bodies respond to it is complicated. From the very first bite, food kicks off a chain reaction, signals moving between the gut, the brain, the immune system, a constant back and forth we can't see and often don't fully understand. Introducing Eating Interrupted, a new podcast from iHeartRuby Studio. Hosted by longtime journalist and Crohn's patient Cynthia McFadden, Eating Interrupted explores everything from food allergies and intolerances and why they seem to be on the rise to how digestion changes as we age and what it's really like to live with a chronic GI condition.

14:26Through personal stories and expert insight, Listen in to unpack what it means when your body doesn't always respond to food the way you expect and what science is now revealing about why. Listen to Eating Interrupted on the iHeart app, Apple Podcasts, or wherever you get your podcasts. Are you looking for support in your weight management journey? ZepBound Terzepatide may be able to help. ZepBound is a prescription medicine used with a reduced calorie diet and increased physical activity to help adults with obesity, or some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off.

15:04ZepBound is approved as a 2.5, 5, 7.5, 10, 12.5, or 15 milligram injection. ZepBound contains terzepatide and should not be used with other terzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if ZepBound is safe and effective for use in children. Don't share needles or pens or reuse needles. Don't take if allergic to it. Or if you or someone in your family had medullary thyroid cancer, or if you've had multiple endocrine neoplasia syndrome type 2, tell your doctor if you get a lump or swelling in your neck. Stop ZepBound and call your doctor if you have severe stomach pain or a serious allergic reaction.

15:41Severe side effects may include inflamed pancreas or gallbladder problems. Tell your doctor if you experience vision changes before scheduled procedures with anesthesia. If you're nursing, pregnant, plan to be, or taking birth control pills. Taking ZepBound with a sulfonylurea or insulin may cause low blood sugar. Side effects include nausea, diarrhea, and vomiting, which can cause dehydration and worsen kidney problems. Talk to your doctor. Call 1-800-545-5979 or visit zepbounds.lily.com. Hey, this is Kevin. This is Joe. And this is Nick from Hey Jonas. You know, I recently learned that every 36 minutes, another child in the U.S.

16:20is diagnosed with cancer. Think about that for a second. Some of the bravest warriors you'll ever meet aren't professional athletes or superheroes. They're kids in this fight. And every day, these young warriors face challenges most adults couldn't imagine. Yet they continue to show up with incredible courage, determination, and hope. That's why we're proud to support Hyundai Hope on Wheels. For the past 28 years, with support from Hyundai, their dealers, and every new Hyundai sold, Hope on Wheels has contributed over$300 million to childhood cancer research, helping save more than 40 ,000 kids.

16:51But we're not done yet. We need your help. Together, let's bring every warrior home. Learn more at HyundaiUSA.com slash Hope on Wheels or ask about Hope on Wheels at your local Hyundai dealer. You're the best field operative I've ever had. You were born for it. In 81, the embassy went down. We go 25 million in the wall. Where? Hotel Tehran. This is bad. like run for the hills band. Do it now. I don't have the money, but I've got something more valuable. You shall know the truth. The truth. Don't make it free. The Fix, in theaters September 11th.

17:42Have you heard of or do you know about penile transplant? Did I ever make it in your news feed? I believe there is a concept album by the Kinks called Percy, which is about the first penile transplant, which I thought until this moment was more or less the realm of fiction. So I'm about to learn a lot. That is a deep cut from the Kinks. You're exactly right. Yeah. They took a lot of flack for Lola, by the way. I don't know if you followed that story. They were like, no, this was actually very transpositive. People weren't really listening to the lyrics. So they were a very progressive band, one of the more progressive of the British invasions and the least known of the big four.

18:23But yes. Well, no, penile transplants actually have happened. There have been a few over the years, literally a few, up to five, I think, the last time I checked, including in the United States. And so very similar to anything, a kidney transplant, heart transplant, lung transplant, if a man has had a traumatic or there is still, we talked about a little bit penile cancer where you have to amputate the penis to save a man's life. Penile transplants may be an interesting option and it works just like anything else where a man dies usually traumatically and we can procure the penis really as much of it as we possibly can to transplant on and reattach nerves and blood vessels.

19:05And so that might be an option for traumatic penile injury and amputation. So not as obscure as you might think. Chances of it happened to any of our listeners is thankfully very, very low, but it's out there. I mean, the main thing is, is making sure that you're not at risk of amputating your own penis through a mental health crisis. So that was my little PSA for making sure you have good support for that. Oh, that was heavy, got heavy fast, right? Yeah, very heavy. I mean, I still am just stunned by How often do you, I mean, you've done these surgeries. Yeah. It seems incredibly different. I mean, I've never heard of nerve transplants before.

19:48Yeah. I mean, this is a multidisciplinary surgery where you need a urologist. You need a plastic surgeon that specializes in microsurgery at the very least. And as a microsurgeon, I certainly have training for hooking up very small tubes. But nerve transplants and nerve reattachment is something that you really need somebody that specializes in, usually in plastics or potentially even neurosurgery. When we do transmasculine surgeries, again, often it's a urologist is the leader of that team, but also often in concordance with a plastic surgeon that can do the harvest from the forearm. And it's a pretty amazing thing.

20:32I mean, again, this is really pushing the medical boundaries to be able to provide very specialized care for either severe trauma or for our transgender population or, you know, for cancer. So reconstruction of the penis is real and also often very successful. So, yeah. But no, not a very frequent occurrence by any means, but also something that we always train for and at least understand what to do if we can't offer help to these guys. So yeah, what's way more common, way more common is getting back to our intro, which is testicular trauma. And it's almost always athletic. Oh, what do you think about cup use?

21:13Tell me, tell me if we were cups, would that make everything better? I imagine not. I feel like it would bring its own set of complications and yeah, it would probably help with certain things, but right. Yeah. So it's interesting. First of all, it probably does help. I mean, it definitely, I mean, I can tell you as a baseball player, played first base, taking more than one shot to the nut. And it still hurts, but it probably does help protect. The problem is when we actually look at real world data of high school athletes, of college and pro athletes, the compliance rate for protective testicular scrotal gear is about 36%.

21:56So that's really not good, right? So the people that should be wearing cups, and the reason is they're uncomfortable. And I have a friend and colleague who's been working with a bunch of engineers to make, and maybe we'll have them on someday, maybe because beyond prototypes. But there are people out there that have tried to make better, more athletically able cups because you don't want anything to get to wear your performance. You're an elite athlete, and the idea that you're going to wear a cup that could impact your performance is just a non-starter, right? Because your goal is to be as best as you can.

22:30If you're in high school, you want to get to college. If you're in college, you want to get to the pros. Now, you know, there are at-risk positions, say, like catchers, that absolutely have to wear a cup. But they may not wear it while they're batting, which, again, is what happened to the hero of this podcast, the unsung unrecognized hero that that talked about is testicular trauma because when you're hitting you got to run and if you're running and you got a cup chafing you then you end up with a rash and skin breakdown and pain and and so you know you kind of roll the dice and hope you're not that one in a thousand that gets gets dinged but yeah cups are nowhere near as convenient but also uh they can impair in impair performance and so pro athletes football players for example Very, very few of them were CUP.

23:16Now, the other big risk population are the armed services. So our men in the battlefields, and this is kind of an interesting story. I don't want to get too far off topic, but when I was in Colorado, that was sort of during the Gulf War engagements, Afghanistan, where we have gotten pretty good at keeping people alive in battlefield. We have great battle armor. and so genital trauma hasn't really changed much from you know the days of the civil war but those people have died of things before they they had to worry about their testicular injuries because you know they had a gut wound that couldn't be repaired or they bled to death on the field and so battle armor has really evolved and combat injuries and and our our forward care has gotten so good that we can keep guys alive that may not have been able to be alive that had general trauma.

24:09But these general injuries then are the lasting injuries. And you'd think, well, why don't you just have battle armor that protects the testicles? And they do, but it goes into the same thing is that it still hasn't been engineered to the point where it's protective. So I've talked to a lot of soldiers that say, look, I just, you know, I couldn't wear it. It was getting in the way. A lot of this desert fighting is, you know, you're fighting in 110 degree weather, you already have 80 pounds of gear on you. And if you're going to wear something that's going to limit your ability to run, to duck, to do what you have to do to stay alive and to protect your team and to protect your platoon, then a lot of these guys are going without that battle armor on the genitals and hoping for the best.

24:48But unfortunately, if you get hit in the testicles, then that was battle trauma or the penis can really be devastating to your fertility, normal testosterone and sexual function. And so the injuries still are mounting up, especially when we have any kind of ground were obviously where people are in harm's way. But the thing that really sucks about it, and it's starting to change is that when you look at disability in the military, it's often done by size of geography, right? It's the whole real estate question. And so when I was starting in practice, guys that were disabled to the penis and the genitals, they were eligible for what we call a service connection that's based on a percent of their injury.

25:30And because the genitals take up a small percentage of our overall body, genital trauma was getting like a 1 % service connection, right? But that's some pretty expensive real estate there. So if your leg has a much higher, but you have two legs, your arms much higher, but you have two arms. And so there's been a lot of politicking and campaigning to figure out how to improve service connection, because that will help with your disability payouts. And it's expensive if you're discharged from the military and you have a genital trauma that causes sexual dysfunction, that causes fertility, those are all incredibly expensive things that have to be covered that you may not get as good a service connection.

26:09And that's definitely changed. So I'm happy there's been more public as well as a congressional awareness of it. But yeah, testicular trauma in the military is a huge problem. And any ground war, you're going to see an uptick in this. And it's a surgical emergency.

26:38Let's be real. Eating is a huge part of our lives. It fuels us. It brings us together. And yes, it's one of life's great pleasures. But once a meal's over, we don't think much about what happens next, unless something starts to feel off. Because what we eat and how our bodies respond to it is complicated. From the very first bite, food kicks off a chain reaction, signals moving between the gut, the brain, the immune system, a constant back and forth we can't see and often don't fully understand. Introducing Eating Interrupted, a new podcast from iHeart Ruby Studio. Hosted by longtime journalist and Crohn's patient Cynthia McFadden, Eating Interrupted explores everything from food allergies and intolerances and why they seem to be on the rise to how digestion changes as we age and what it's really like to live with a chronic GI condition.

27:30Through personal stories and expert insight, listen in to unpack what it means when your body doesn't always respond to food the way you expect and what science is now revealing about why. Listen to Eating Interrupted on the iHeart app, Apple Podcasts, or wherever you get your podcasts. Are you looking for support in your weight management journey? Zepbound Terzepatide may be able to help. ZepBound is a prescription medicine used with a reduced calorie diet and increased physical activity to help adults with obesity, or some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off.