Everything’s swell: A brief look at scrotal infusion

One of the more unusual male sexual acts that I have come across while researching my blogs is scrotal infusion (and if you have a minute you could check out my articles on urethral stimulation and rectal foreign bodies). This is a sexual practice in which fluid (usually saline solution) is injected into the scrotal sac as a way of making it balloon in size (which is why the practice is sometimes referred to as ‘ballooning’ but not to be confused with balloon fetishism). A very similar practice is scrotal inflation in which air (or other gases) are injected into the scrotal sac. Both scrotal infusion and inflation are potentially dangerous, and individuals engaging in such acts are at risk of scrotal cellulitis, subcutaneous emphysema, Fournier’s gangrene (a type of necrotizing infection or gangrene usually affecting the perineum), and/or air embolism. The latter two complications can be potentially fatal particularly among those with HIV. Local nerve damage can also be caused by improper placement of the injecting needle. If there are no complications, the saline injected into the scrotal sac eventually absorbs into the body over a three-day period. Those who inject too much saline into the scrotum discover that the liquid disperses into the abdomen via a small connecting opening.

To date, there have only been a few case studies published in the medical literature. In 2003, Dr. Jeffrey Summers (East Tennessee State University, US), published a case study in the Southern Medical Journal. Summers reported that a 37-year old man turned up for medical attention with a very swollen and painful scrotum.

“[The man] reported that he had always had the impression that his genitalia were smaller than desired, and as a result he had searched the Internet for a solution. He found a web site that supplied him with a “scrotal inflation kit”…Unfortunately, the patient still had enlargement of the scrotum 4 days after the infusion, and it was quite painful…He was initially pleased with the results, but then he developed erythema and pain during the next 2 days…The swelling of the scrotum completely consumed his penis. At 2-week follow-up [following treatment], the patient’s erythema had nearly resolved, and his scrotum was reduced to approximately 20% of its size at presentation”.

In his discussion of the case, Summers noted that “the term scrotal inflation seems to be common in the lay literature” but they could only locate two previous studies relating to gaseous inflation of the scrotum (one paper from 1969 published in the Henry Ford Hospital Medical Journal, and one in 1980 published in American Surgery). The issue most stressed by Summers was that “remarkably, the equipment required for scrotal inflation can be obtained over the Internet without a prescription”. The most recent case was reported by Dr. K.G. Yoganathan and Dr. A.L. Blackwell in a 2006 issue of the journal Sexually Transmitted Infections. They reported that a 52-year old man (white, gay, and HIV positive) turned up at their hospital wanting medical attention for a painful scrotum:

“He had obtained information and a disposable scrotal infusion toolkit from a websiteand had infused 2 litres of normal saline into his scrotum over 2 hours, 3 days previously. He had done this many times before without complications and the swelling had previously resolved over 2 days. On this occasion he sought medical advice because the pain and swelling had lasted for more than 3 days…Examination revealed a grossly swollen, erythematous, tender scrotum suggestive of severe cellulitis…A Prince Albert ring and scars from previous infusions were also noted…Despite the severity of his illness, the patient declined to stop this practice and he was therefore advised on how to reduce the risk of complications”.

The authors recommended that patients should be educated about the dangers of inflation procedures of scrotum and strongly discouraged from doing it. They also said that clinicians should be aware of unusual sex practices and associated possible rare causes of scrotal cellulitis (such as scrotal infusion and inflation). Dr. Brenda Love in both her Encyclopedia of Unusual Sex Practices, and a 2005 book chapter (in Russ Kick’s book Everything You Know About Sex is Wrong) notes that:

“The visual effect of the scrotal infusion resembles a water balloon. Men do not report any pain from this procedure and claim that one advantage is found the next morning when the solution filters into the penis, causing it to swell to the size of a beer can. Men claim exclusive license to this type of sex play. There is no sealed part of the female anatomy that has a hollow sac that lends itself to expansion”

Brenda Love points out that there is much preparation and associated paraphernalia needed to engage in acts of scrotal infusion. Love’s equipment list includes: scissors, first-aid tape, a 20-gauge angiocath/hypodermic needle, a one-litre plastic bag of saline solution, an intravenous pole/hook on the ceiling, plastic tubing, latex gloves, and packaged alcohol prep pads. She appears to provide a first-hand account of an actual scrotal infusion that she either watched or had described in depth to her:

“The saline solution was warmed to body temperature ahead of time. The bag was then held against the inside wrist to determine a comfortable temperature. Incidentally, the temperature is not for the comfort of the patient but rather to prevent the scrotal sac from shrinking, as it normally does when exposed to cold water or ice. This shrinking would hamper the expansion process that is essential for infusion. The bag was hung from a hook and spiked with the tubing, which was then pinched closed, not contaminating either of the ends. The scrotal area was swabbed with the alcohol prep pad, and the needle was inserted about one inch directly below the base of the penis in the middle of the scrotum. The partner waited for a moment to make certain that he had not pierced a vein (evident by blood backing up into the needle); the needle was then taped flat and upright against the top of the scrotum. The tubing was opened and adjusted so that it drained at a rate of about 60-90 cc per minute. The male stood because gravity helps to facilitate the expansion. However, fainting is a natural response, and the person was monitored closely and had a bed or table behind him on which to lie if necessary”.

Most people (including myself) may be puzzled as to why someone would want to engage in the activity of scrotal infusion in the first place. Brenda Love claims in her book chapter that those males who participate in this form of body modification explain that they experiment with such dangerous behaviour to (i) experience different feelings, (ii) to be unique, (iii) for the shock value, (iv) to prove that these are their genitals and they will do with them as they please, and to (v) visually set their genitals apart from all others.

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

Further reading

Bush, G. & Nixon, R. (1969). Scrotal inflation: a new cause for subcutaneous, mediastinal and retroperitoneal emphysema. Henry Ford Hospital Medical Journal, 17, 225–226.

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Love, B. (2005). Cat-fighting, eye-licking, head-sitting and statue-screwing. In R. Kick (Ed.), Everything You Know About Sex is Wrong (pp.122-129).  New York: The Disinformation Company.

Summers, J. (2003). A complication of an unusual sexual practice. Southern Medical Journal, 96, 716–717.

Wikipedia (2012). Scrotal inflation. Located at: http://en.wikipedia.org/wiki/Scrotal_inflation

Yoganathan, K. G.; Blackwell, A. L. (2006). Unusual cause of acute scrotal cellulitis in an HIV positive man. Sexually Transmitted Infections, 82, 187-188.