Here’s What Happens After Your Penis Freezes, According to a Urologist

February 19 was one of the most important days of Remi Lindholm’s life. For the first time, the Finnish cross-country skier had made it to the Olympics, and now it was time to race. The conditions in Beijing were brutal that day: It was 1.4 degrees Fahrenheit outside, but 40-mile-an-hour winds made it feel closer to -26. Aside from his undergarments, gloves, and a hat, a thin speed suit was all Lindholm had to protect himself from the elements, which he would have to brave for more than an hour. The race was delayed in the hope that the weather might improve, but it wouldn’t let up. Eventually, after shortening the race from 50 kilometers to 30, Olympic organizers decided they couldn’t wait any longer. Lindholm took his place beside 59 other skiers and braced himself against the cold. The starting gun fired, and he hurled himself down the course.

Like everyone there, Lindholm was dreaming of glory—of seizing this moment, so many years in the making, and emerging at the finish line a champion. But it was not to be. Instead of walking away with a gold medal, Lindholm hobbled off the course with a frozen penis. 

The worst was yet to come. Desperate to regain feeling in his frosty, wind-whipped genitals, Lindholm grabbed a heat pack and stuck it down his pants. But as his penis warmed back up, he told Finnish media, “the pain was unbearable.”

News of Lindholm’s unfortunate fate traveled far and wide. After Reuters ran a story on the incident, it was picked up by the BBC, CNN, ESPN, and, naturally, the Daily Mail, along with dozens of other outlets. As I read about what happened to Lindholm, a number of questions sprang to mind. How often do penises freeze? How does one treat such an injury? And even after the pain subsides, what long-term health complications might plague the poor souls who find themselves in this position?

Looking for answers, I called up Dr. Seth Cohen, an assistant professor of urology and the director of the Sexual Dysfunction Program at NYU Langone. He told me everything one would possibly want to know about frozen penises, and many things one would not.

VICE: Have you ever heard of someone’s penis freezing before?

Dr. Seth Cohen: I’ve heard of a lot of things going wrong with the penis. Freezing is not one of them. I see about 25 to 30 patients a day with different sexual-health penile issues, and this is the first time I’ve ever heard of this. The caveat there is: I work in New York City. I don’t think we hit temperatures low enough, with enough ambient exposure, [for this to happen]. Do you know what temperature it was outside at that specific event?

Reportedly, it was 1.4 degrees Fahrenheit, but there were 40-mile-an-hour winds. So it felt closer to -26 degrees.

Wow. When you’re talking about temperatures that low, you can freeze off freaking anything. Distal extremities go first, like fingers and toes, and of course the penis is a distal extremity. That’s because these things are end organs. End organs have an artery that goes to the end of the tip, and then a vein that brings all the blood flow back. You don’t have any accessory arterial blood flow. So if that specific flow of blood gets blocked, or frozen, or constricted for any reason, that organ starts to lose oxygenated blood. That’s what frostbite is: It’s when you get a constriction of a blood vessel, there’s no blood flow to that area for a prolonged period of time, and that leads to end organ damage. 

It’s less likely to happen in your internal organs, like your liver or kidney or bowels, because you have accessory arteries and accessory veins. If one artery goes down, you have other arteries that can pick up to help. So the reason why in cold temperatures, people lose fingers and toes, the tip of the nose, and I guess other extremities, is because you only have one or two blood vessels going to that area. 

Lindholm said that after he finished the race, the pain of thawing out his penis was “unbearable.” Could you describe what’s happening, on a medical level, that would make that thawing process so painful?

You have a situation where you’re constricting blood flow to an area that needs that blood flow. You need blood flow to maintain the health of the tissue, the nerves, and any of the surrounding structures. If you’ve constricted the blood flow to that area, the area is not going to survive for very long. 

Once there’s a return of blood flow, you basically have areas that are now becoming engorged with warm blood in otherwise cold, frostbitten tissue. Why does that hurt? Traumatized nerves are sending signals to the brain that they’re not happy. These are nerves that have been struggling for oxygenated blood. Now they get a ton of it. They’ve gone numb. And when numb things wake up, they usually wake up like a charley horse. It’s like if you’re sitting too long and you have those pins and needles on the end of your feet. It doesn’t feel very good.

Once he warmed up his penis, the blood flow came back. That’s very painful. It’s the same as anyone who’s ever experienced near-freezing temperatures in their fingers and toes. When you start to warm it back up, it feels pretty awful. So you can only imagine what that must feel like in the penis.

Would you say the pain of thawing out would be worse in the penis than in other parts of the body?

I have to imagine. I mean, the penis is one of the most well-innervated organs of our body. Anything that will alter or inhibit or intensify sensations in the penis is either going to feel good or feel really, really awful. So a frostbite or a burn, it’s just not a good area to have that. 

After someone’s penis freezes, what further health issues could they have? Are there long-term complications you might worry about?

Definitely. If he had lingering pain for hours to days, I certainly would be worried that maybe some damage, maybe even permanent damage, has been done. You’ve seen those Everest movies where they come out and they get frostbite in their fingers and nose. That doesn’t just go back to normal. You could lose the tip of your finger. You could lose the tip of your nose. 

So let’s say lasting damage was done. The end point of any organ is your skin. That’s your last layer of protection. That’s probably going to be the first thing to fall off. So skin can slough off. Underneath the skin are other important tissue structures of the penis. The tip of the penis has spongy tissue underneath it, and that tissue can also be injured and damaged. There are nerves that can be injured and/or damaged. We’re just talking about the tip of his penis. But if the whole shaft were damaged, we could be talking about loss of skin on that area and loss of organ function.

Best-case scenario, everything goes back to normal. Worst-case scenario, he has permanent nerve damage, he has skin tissue that can fall off and slough off. And none of that’s going to be nice. It’s going to leave ugly scars. 

If your penis freezes, could it affect your reproductive health?

When we talk about mens’ reproductive health, that’s mostly your testicles. The article that I read [about Lindholm] didn’t mention anything about his testicles being frozen. It was just his penis. If he also had testicular ischemia [Ed. note: meaning “constricted blood flow”] and testicular frostbite, that would be really bad. That would be another one that I’ve never heard of.

If you get frostbite of the testicles, that can injure your sperm production. If the penis still works—meaning it still gets erect, you can still have sex activity with it, and you can still ejaculate fluid through your urethra—then I don’t see why his fertility would be affected. But if the nerves were damaged, or the blood supply to his penis was damaged, then you’re definitely talking about fertility issues. Not because of sperm issues, but because of impotency. He couldn’t perform. And I hope that’s not—how old is this guy?

He’s 24.

Oh, good lord. Yeah, that would be a really bad situation to be in for him. God never created the penis and testicles to have these injuries. But the penis can take a beating and heal. So I’m hopeful he can heal up and make a full, 100 percent recovery. The body has an amazing ability, especially at 24, to heal itself. 

Apparently, this isn’t the first time Lindholm’s penis has frozen while he was skiing. It also happened to him during a race last year in Finland. Does that make you more concerned about this injury, knowing it wasn’t an isolated incident?

If this happened to him before, you would have thought it would have been a wake-up call. Like, maybe you should be wearing more protective undergarments. The other question that you might have is, does he have some anatomical aberration or defect that puts him more at risk for frostbite than somebody else? What would that be? I don’t know—some vascular anomaly that would lead him to have poor blood supply to his penis? I think that’s pretty rare. I can’t think of one off the top of my head that would put him or anyone else at increased risk for frostbite on their penis. But if it happened to him once, it’s like, why didn’t you take more precaution the second time?

Let’s say that after Lindholm’s penis froze, he came to you for treatment. What would you do? And what would you keep an eye on in the weeks after it happened?

In the acute, we have to keep a close eye on it. We have to monitor his outcomes: monitor for morning erections; if he wants to manually masturbate, see if normal blood supply and blood flow is coming back; make sure that he has normal urinary function and urinary flow, and normal ejaculatory function and orgasmic function. There’s special testing that can be done to test the nerves of the penis, and make sure he doesn’t have any sensory defects, or any areas of the penis that are completely numb. And of course, we’d do a visual check. Is there any skin sloughing? Necrosis of tissue? Black areas that would be like an eschar? Gangrene of the skin? Penile color changes? All of these things we would monitor over the course of weeks to months. And then you have to just sort of wait and see. 

What advice might you give Lindholm to prevent this from happening to him again?

I think he should probably do, like, men’s summer volleyball. I’m sort of joking, but I’m sort of serious. Like, if you have visual, optic defects, they don’t let you become a pilot—for good reason, right? This happened to him twice. If he wore all the protective gear that everybody else wears and it’s still happening to him, this may not be the right sport for him. It’s one thing to toughen up and push past something if there’s a little pain or discomfort in the fingers and the toes or in the nose, but if this is happening to a very vital organ to his future fertility and future intimate life, it doesn’t seem like it makes a lot of sense to continue doing it. But I’m not him.

Drew Schwartz is a staff writer at VICE. Follow him on Twitter.