A lowdown on the urethra (frankly): Urethral manipulation uncovered

While I was researching a previous blog on urophilia, I came across a number of articles and papers on urethral manipulation fetishes (i.e., people that get sexually aroused from the insertion of ‘foreign bodies’ into their urethra). Almost all of the published work in this area is in the form of clinical and/or medical case reports, and almost all of the cases are men who insert various objects into their penis as a form of stimulation. (Having said that, various authors have noted women may also engage in urethral stimulation). Furthermore, most of the case reports are from men who have ended up having to seek medical help because the ‘foreign body’ has become stuck inside their penis (so most of what we know is only based on urethral manipulation and stimulation that goes wrong). Based on case reports, it is estimated that almost all men and about 85% of women who engage in urethral manipulation do it for sexual stimulation. Other reasons for urethral manipulation include psychiatric disorders, drug intoxication, mental confusion, sexual curiosity, and/or a desire to get relief from urinary symptoms.

There is also a relatively developed lexicon (particularly among the gay community) for such urethral stimulating behaviours including the following:

• Sounding: The insertion of an object into the urethra
• Meatotomy: The dilation of the urethra with a medical dilating device (so that the urethra is stretched to eventually facilitate a finger or a penis)
• Meatotome: An instrument used to enlarge the urethral opening
• Meatorrhaphy: The procedure of enlarging the urethral opening
• Meatometer: An instrument for measuring the urethral opening

The range of different objects that have been used include straws, cylindrical batteries, pens, pencils, candles, lipstick containers, small wooden sticks, swizzle sticks, glass beads, wires, Allen keys. buckshot, cuticle knives, and razors. Such practices can lead to a wide array of medical problems including (but not limited to) urinary tract damage and blockages, urinary tract infections, and bladder infections. For instance, in a 1999 book on gay sex, Dr S.E. Goldstone reported the case of a man who inserted a piano wire into his penis that resulted in it getting knotted in his bladder (and his bladder had to be cut open to get it removed).

A report of seven cases in a 1982 issue of the Journal of Sex and Marital Therapy by Wise (1982) reported that urethral stimulation may occur actively during sexual activity (e.g., masturbation) activities, or passively via medical procedures requested by the person. He also observed that the behaviour shares features with both fetishism and masochism (although very few of those who engage in such practices report pain so the association with masochism does not seem justified based on the clinical evidence reported. In the journal Urology, Dr R.D. Kenney’s believed that the initiating event in the acquisition of such behaviour is an accidentally discovered pleasurable stimulation of the urethra, and then repeated using objects of unknown danger, driven by a psychological predisposition to sexual gratification.

Most reports are medical in origin although some psychoanalysts claim that those with a fetish or preference for urethral stimulation have underlying problems of fixation or regression and castration anxiety (but there is little way of either proving or disproving such theories). Reviews of data from case reports suggest that the focus of arousal for the individual is not on the objects that are inserted into the urethra.

Arguably the most comprehensive paper on ‘penile foreign body insertion’ the was a 2000 paper published in the Journal of Urology by Dr. A. Van Ophoven and Dr J.B. de Kernion. They reviewed 800 cases in the published literature between 1755 and 1999. The range of inserted objects were categorized into a number of distinct categories the following categories:

• Animals or parts of animals (e.g., coyote’s rib, dog’s penis, leech, snails, animal bones)
• Plants and vegetables (e.g., slippery elm, grass, cucumbers, pistachio shells)
• Sharp and lacerating objects (e.g., pencils, pins, needles)
• Wire like objects (e.g., cables, catheters, rubber tubes)
• Fluids and powders (e.g., nasal mucus, glue, cocaine)

However, individual case reports have included some really bizarre and unusual objects. A 1992 case study reported by Dr. A.K. Jaiswal (Command Hospital, Bangalore, India) in the journal Genitourinary Medicine reported a 28-year old Indian man who ended up getting a penicillin bottle (containing iodine) stuck in the preputial sac. The man had inserted the bottle during masturbation to tickle his penile glans. It was so firmly impacted that the bottle could only be removed under general anaesthetic.

In a 2002 issue of Urology, Dr E.D. Kim and colleagues (University of Tennessee Medical Center, Knoxville, USA.) reported what they believed was a unique case of a 41-year old man who presented himself for medical attention as a result of a urethral blockage. It turned out that the lower urinary tract obstruction was because the man had self-injected foam sealant into his urethra.

In 1997, Dr Paul Lamberth reported the case in Emergency Medicine of a 36-year old man who inserted a safety pin into his urethra for sexual pleasure. After 10 hours of failing to remove the safety pin, he sought medical attention. Lambirth claimed this was only the second such case (of using safety pins) to be reported in the medical literature.

The insertion of foreign bodies into the penis is rarely fatal. However, a 1982 paper in the American Journal of Forensic Medicine and Pathology by Dr R.W. Byard and his colleagues reported that a 40-year-old man inserted a pencil into his penis but he was unable to remove it. Unfortunately, he failed to seek medical help and he developed a septic condition and died as a consequence. Given that almost all reports of urethral sexual stimulation are case study reports, there are no estimates as to how prevalent this sexual practice is among the general population.

A recent 2011 paper by Dr S.D Chattopadhyay and colleagues (Nilratan Sircar Medical College and Hospital, Kolkata, India) in the Jurnalul de Chirurgie, Iasi asserted that the insertion of foreign bodies into the urethra as a paraphilic behaviour is “fraught with complications”. They reported the case of a 25-year old male goldsmith who had inserted a 60cm electrical wire with a 5mm diameter into his urethra. The wire got stuck and caused heamaturia (i.e., blood in his urine) and incontinence along with a lot of pain and discomfort. It was removed by open cystoscomy (opening up the bladder during an endoscopic procedure). The authors associated the behaviour to a depression and anxiety condition, and was subsequently prescribed antidepressants to prevent any future occurrences. Similar cases have also been reported in various other papers. For instance, Dr Konstantinos Stravodimos and colleagues (Laiko Hospital, Athens, Greece) reported in the Journal of Medical Case Reports (2009) that a 53-year old Greek man presented with a bloody urethral discharge after having inserted an electrical wire in his urethra for masturbatory purposes.

In a 2010 issue of the Journal of the Royal Society of Medicine, Dr Nishant Bedi and his colleagues (Bart’s and The London NHS Trust, London, UK) reported the case of a 62-year-old man who had inserted two small household (AAA size) batteries into his urethra that had got stuck and was in pain. This was not an isolated incident as the year before, the same patient had an endoscopic procedure to remove a pen lid from his urethra.

In the International Journal of Neurourology (2010), Dr Seung Jin Moon and colleagues (Hanyang University, Seoul, Korea) reported the case of a 50-year-old man who sought medical treatment after a week long period of pain. It turned out that three years previously he had inserted a plastic chopstick into his urethra for sexual pleasure (although this had not caused any pain despite the fact that it remained inside him). However, the patient more recently had inserted a round magnet into his urethra in an attempt to remove the chopstick. However, this failed to remove the chopstick and he then got the magnet stuck. He then inserted a second magnet in an attempt to remove the first magnet when the second magnet got lodged in his urethra. The authors observed that their case was very interesting because a foreign body had remained in the bladder for a long time without causing severe irritation and pain.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bedi, N., El-Husseiny, T., Buchholz, N. & Masood, J. (2010). ‘Putting lead in your pencil’: Self-insertion of an unusual urethral foreign body for sexual gratification. Journal of the Royal Society of Medicine Short Reports, 1(2), 18.

Byard, R.W., Eitzen, D.A., James, R. (2000). Unusual fatal mechanisms in nonasphyxial autoerotic death. American Journal of Forensic Medicine and Pathology, 21, 65-8.

Chattopadhyay, S.D., Das, R., Panda, N., Mahapatra, R.S., Biswas, R., & Jha, A. (2011). Long electric wire in urethra – an unusual paraphilia. Jurnalul de Chirurgie, Iasi, 7, 437-440.

Goldstone, S.E. (1999). The Ins and Outs of Gay Sex: A Medical Handbook for Men. New York: Dell Publishing.

Jaiswal, A.K. (1992). An unusual foreign body in the preputial sac. Genitourinary Medicine, 68, 334-5.

Kenney, R.D. (1988). Adolescent males who insert genitourinary foreign bodies: Is psychiatric referral required? Urology, 32, 127-129.

Kim, E.D., Mory, A., Wilson, D.D. & Zeagler, D. (2002). Treatment of a complete lower urinary tract obstruction secondary to an expandable foam sealant. Urology, 60, 164.

Stravodimos, K.G., Koritsiadis, G. & Koutalellis, G. (2009). Electrical wire as a foreign body in a male urethra: a case report.  Journal of Medical Case Reports, 3, 49

Mitchell, W. M. (1968). Self-insertion of urethral foreign bodies. Psychiatric Quarterly, 42, 479-486.

Moon, S.J. Kim, D.H., Chung, J.H., Jo, J.K., Son, Y.W., Choi, H.Y. Moon, H.S. (2010). Unusual foreign bodies in the urinary bladder and urethra due to autoerotism. International Neurourology Journal, 14, 186-189.

van Ophoven, A. &  deKernion, J.B. (2000). Clinical management of foreign bodies of the genitourinary tract. Journal of Urology, 164, 274-87.

Vilmann, D. & Hjortrup, E.A. (1985). Long-standing urethral instrumentation leading to an unusual complication. Scandinavian Journal of Urology and Nephrology, 19, 147-148.

Wise, T.N. (1982). Urethral manipulation: An unusual paraphilia. Journal of Sex & Marital Therapy, 8, 222-227