I have a question that only you might be able to answer. My brother claims to be well endowed enough that a former “girlfriend” says he bruised one of her ovaries. Now, nothing is totally impossible, but how likely is it that this could happen with normal human beings? Are there ANY cases of it on record? What are the most common injuries from rough sex, anyway?

–Dwayne White, Southside High School

Not to suggest your brother was jerking you around, Dwayne, but we need to consider the physical realities. Do you have any idea where the ovaries are? Allow me to give you a little tour. Entering the female reproductive system by means of the vagina, we travel four to five inches until we reach the cervix, the muscled entrance to the uterus. The cervix normally is tightly closed, although it can dilate, not without difficulty, to allow passage of babies, IUDs (inserted through a straw), etc. Arriving in the uterus, a fist-sized organ located an inch or two below the waistline, we then make a sharp right or left turn to reach the fallopian tubes. The tubes are three to four inches long with an inner diameter the size of a human hair. They connect the uterus to a point near the ovaries, curving around a good deal in the process. In other words, to bruise an ovary directly, your brother would need a member like one of those scary prehensile tentacles in Men in Black II. If he’s got one, all I know is, he’s never getting in the backseat of a Chevy with me.

That’s not to say a woman won’t sometimes experience pain during intercourse with a well-endowed man, or just passionate sex with a normal one. This condition is called deep-thrust dyspareunia. Causes include a prolapsed uterus, “fallen bladder,” uterine fibroids, endometriosis (uterine-lining-type tissue that turns up in places like the ovaries and causes them to adhere), scar tissue in the uterus or ovaries, or an ovarian cyst. In the latter three cases the man isn’t bruising the ovary but rather aggravating an existing problem. (Gynecologist David Cohen of the University of Chicago tells me he’s never heard of the term “bruised ovary.”) A related condition is collision dyspareunia, in which the penis bangs into the cervix or uterus. This problem is associated with a tipped uterus, which is pretty much what it sounds like.

Painful as dyspareunia can be, worse things can happen. We learn this from a recent article entitled “Urological Complications of Coitus” (BJU International, February 2002), by a urological surgeon in Nigeria with the unfortunate name of Dr. Eke. Eke assembled reports on an astonishing 1,454 cases, 790 in men and 664 in women. By far the most common injury in men was penile fracture, which this column has dealt with in the past and which I continue to think is the stupidest injury known to medicine. Injuries in women were more diverse, including lacerations in the vagina and perineum (the area between the vulva and the anus), infections, and so on. Among the factors leading to injury, Eke observed, were forceful coitus, congenital vaginal anomalies, and–here’s where it gets interesting– “penovaginal disproportion.”

Two articles were cited. The first talked about child brides (12 and under) in Nigeria; the second described a couple in India consisting of a “hefty, robust, well built husband and a small, tender wife.” The injury in all cases was a vesicovaginal fistula, a tear between the vagina and the bladder accompanied by intense pain, vaginal bleeding, and incontinence. Mercifully such injuries are rare. Say what you will about the robustness of the men, it strikes me that the real issue was the smallness of the woman and girls. Your brother may think he’s injuring women because he’s hung like a porn star; more likely he’s just too rough.

But who knows? “It is difficult to ascertain the role of the size of the penis and the amount of coital force involved in the aetiology of coital injuries,” Eke laments. Perhaps someday we’ll know more. Cecil’s attention has been drawn to the first magnetic resonance imaging of male and female genitals during coitus and female sexual arousal–see bmj.com/cgi/reprint/319/7225/1596.pdf, plus a charming commentary by one of the participants at www.abc.net.au/rn/science/ss/stories/s250347.htm. It’s all very well doing it on the pitcher’s mound, on videotape, etc, but you haven’t lived till you’ve done it on MRI.

Art accompanying story in printed newspaper (not available in this archive): illustration/Slug Signorino.