Category Archives: Gender differences
Strange, bizarre and unusual human sexual behaviour is a topic that fascinates many people (including myself of course). Last week I got a fair bit of international media coverage being interviewed about the allegations that Donald Trump hired women to perform ‘golden showers’ in front of him (i.e., watching someone urinate for sexual pleasure, typically referred to as urophilia). I was interviewed by the Daily Mirror (and many stories used my quotes in this particular story for other stories elsewhere). I was also commissioned to write an article on the topic for the International Business Times (and on which this blog is primarily based). The IBT wanted me to write an article on whether having a liking for strange and/or bizarre sexual preferences makes that individual more generally deviant.
Although the general public may view many of these behaviours as sexual perversions, those of us that study these behaviours prefer to call them paraphilias (from the Greek “beyond usual or typical love”). Regular readers of my blog will know I’ve written hundreds of articles on this topic. For those of you who have no idea what parahilias really are, they are uncommon types of sexual expression that may appear bizarre and/or socially unacceptable, and represent the extreme end of the sexual continuum. They are typically accompanied by intense sexual arousal to unconventional or non-sexual stimuli. Most adults are aware of paraphilic behaviour where individuals derive sexual pleasure and arousal from sex with children (paedophilia), the giving and/or receiving of pain (sadomasochism), dressing in the clothes of the opposite sex (transvestism), sex with animals (zoophilia), and sex with dead people (necrophilia).
However, there are literally hundreds of paraphilias that are not so well known or researched including sexual arousal from amputees (acrotomophilia), the desire to be an amputee (apotemnophilia), flatulence (eproctophilia), rubbing one’s genitals against another person without their consent (frotteurism), urine (urophilia), faeces (coprophilia), pretending to be a baby (infantilism), tight spaces (claustrophilia), restricted oxygen supply (hypoxyphilia), trees (dendrophilia), vomit (emetophilia), enemas (klismaphilia), sleep (somnophilia), statues (agalmatophilia), and food (sitophilia). [I’ve covered all of these (and more) in my blog so just click on the hyperlinks of you want to know more about the ones I’ve mentioned in this paragraph].
It is thought that paraphilias are rare and affect only a very small percentage of adults. It has been difficult for researchers to estimate the proportion of the population that experience unusual sexual behaviours because much of the scientific literature is based on case studies. However, there is general agreement among the psychiatric community that almost all paraphilias are male dominated (with at least 90% of all those affected being men).
One of the most asked questions in this field is the extent to which engaging in unusual sex acts is deviant? Psychologists and psychiatrists differentiate between paraphilias and paraphilic disorders. Most individuals with paraphilic interests are normal people with absolutely no mental health issues whatsoever. I personally believe that there is nothing wrong with any paraphilic act involving non-normative sex between two or more consenting adults. Those with paraphilic disorders are individuals where their sexual preferences cause the person distress or whose sexual behaviour results in personal harm, or risk of harm, to others. In short, unusual sexual behaviour by itself does not necessarily justify or require treatment.
The element of coercion is another key distinguishing characteristic of paraphilias. Some paraphilias (e.g., sadism, masochism, fetishism, hypoxyphilia, urophilia, coprophilia, klismaphilia) are engaged in alone, or include consensual adults who participate in, observe, or tolerate the particular paraphilic behaviour. These atypical non-coercive behaviours are considered by many psychiatrists to be relatively benign or harmless because there is no violation of anyone’s rights. Atypical coercive paraphilic behaviours are considered much more serious and almost always require treatment (e.g., paedophilia, exhibitionism [exposing one’s genitals to another person without their consent], frotteurism, necrophilia, zoophilia).
For me, informed consent between two or more adults is also critical and is where I draw the line between acceptable and unacceptable. This is why I would class sexual acts with children, animals, and dead people as morally and legally unacceptable. However, I would also class consensual sexual acts between adults that involve criminal activity as unacceptable. For instance, Armin Meiwes, the so-called ‘Rotenburg Cannibal’ gained worldwide notoriety for killing and eating a fellow German male victim (Bernd Jürgen Brande). Brande’s ultimate sexual desire was to be eaten (known as vorarephilia). Here was a case of a highly unusual sexual behaviour where there were two consenting adults but involved the killing of one human being by another.
Because paraphilias typically offer pleasure, many individuals affected do not seek psychological or psychiatric treatment as they live happily with their sexual preference. In short, there is little scientific evidence that unusual sexual behaviour makes you more deviant generally.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153-168.
Buhrich, N. (1983). The association of erotic piercing with homosexuality, sadomasochism, bondage, fetishism, and tattoos. Archives of Sexual Behavior, 12, 167-171.
Collacott, R.A. & Cooper, S.A. (1995). Urine fetish in a man with learning disabilities. Journal of Intellectual Disability Research, 39, 145-147.
Couture, L.A. (2000). Forced retention of bodily waste: The most overlooked form of child maltreatment. Located at: http://www.nospank.net/couture2.htm
Denson, R. (1982). Undinism: The fetishizaton of urine. Canadian Journal of Psychiatry, 27, 336–338.
Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.
Greenhill, R. & Griffiths, M.D. (2016). Sexual interest as performance, intellect and pathological dilemma: A critical discursive case study of dacryphilia. Psychology and Sexuality, 7, 265-278.
Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, 42, 1383-1386.
Griffiths, M.D. (2012). The use of online methodologies in studying paraphilias: A review. Journal of Behavioral Addictions, 1, 143-150.
Griffiths, M.D. (2013). Bizarre sex. New Turn Magazine, 3, 49-51.
Massion-verniory, L. & Dumont, E. (1958). Four cases of undinism. Acta Neurol Psychiatr Belg. 58, 446-59.
Money, J. (1980). Love and Love Sickness: The Science of Sex, Gender Difference and Pair-bonding, John Hopkins University Press.
Mundinger-Klow, G. (2009). The Golden Fetish: Case Histories in the Wild World of Watersports. Paris: Olympia Press.
Skinner, L. J., & Becker, J. V. (1985). Sexual dysfunctions and deviations. In M. Hersen & S. M. Turner (Eds.), Diagnostic interviewing (pp. 211–239). New York: Plenum Press.
Spengler, A. (1977). Manifest sadomasochism of males: Results of an empirical study. Archives of Sexual Behavior, 6, 441–456.
In a previous blog I briefly examined semen fetishes and the acts of ‘bukkake’ (most commonly seen in hard core pornographic films where a group of men all simultaneously ejaculate over a women or man), and ‘gokkun’ (where a man or woman consumes the semen of one or more men from a drinking receptacle, e.g., cups, glasses, beakers, etc.). In that article I noted that while there is a fair amount of (non-academic) literature about bukkake, references to semen fetishes appear to be rare with nothing published in academic journals.
However, since writing that article, a case study of a 39-year old man with an ‘ejaculate fetish’ was published in the Journal of Psychiatry by three Turkish medics (Dr. Safak Taktak, Dr. Mustafa Karakus and Dr. Salih Murat Eke) – ‘The Man Whose Fetish Object is Ejaculate: A Case Report’. (In fact, Dr. Taktak has published a number of interesting case studies of paraphilic behaviour including shoe fetishism and paraphilias more generally [see ‘Further reading’ below]). Following a crime of molestation, the man had been arrested by Turkish police. (In fact, it turned out the man had already spent 10 years in prison for armed robbery when he was in his twenties and was released from jail when he was 31 years old).
The judicial authorities demanded that the man had to undergo a psychiatric assessment because one of his behaviours was the buying of ejaculate from young men that he would then smear on his genitals for sexual satisfaction. The act of smearing semen on his body had begun in prison when he would smear semen on bodily wounds and provided (presumably therapeutic) relief (as the prison did not provide medicine or cream for bodily injuries). The paper also claimed that the act of taking semen from each other and applying it to wounds and sores was commonplace in the prison he was at. Following his release from prison, he continued the habit and “became obsessed with it and he bought semen from different people on a monthly basis and spread it on the genital area”. Fifteen days prior to his psychiatric assessment, he was accused of molesting a 16-year old adolescent while trying to buy semen from him. The adolescent was reported as saying:
“A man held my arm and said that he had a job for me and he would give money if I do that job. I told him if I can do, I would do. He said he would be there [an hour and a half] later, and told me to find him. After he came, he told me that he buys human sperm, and asked me if I give him sperm, which surprised me a lot. Then he took three or four plastic bags out of the pocket of his jacket full of white things. He said these bags are the sperms that he bought from three or four kids. In exchange of sperm, he gave things like money, stereos and televisions”.
The adolescent’s father found out what had happened to his son and caught the man who had wanted his son’s semen. The man told the father that he wanted the semen to alleviate itchiness. During the psychiatric examination by the authors, the man was described as having mildly depressive emotions, natural psychomotor activity, sufficient cognitive function, and no delusions and/or hallucinations. He also had a history of alcohol and marijuana abuse (but since leaving prison he had stopped abusing these substances). Using the Minnesota Multiphasic Personality Inventory (MMPI) the authors said he had inconsistent behaviour, difficulty in controlling his impulses, was angry and short tempered, displayed antisocial behaviour, was sexually deviant, had obsessive sexual thoughts, was socially isolated, and had a negative self-perception. They also wrote that his psychological profile suggested an antisocial or schizoid personality disorder.
The paper also noted that his father has also been in prison on a number of occasions, and that his mother and her relatives looked after him and his younger brother, and that they had “a hard life” while growing up. From the age of 11-12 years old, he started masturbating regularly (sometimes a few times a day). During early adolescence he began engaging in frotteurism (rubbing his genitals up against other people) particularly on bus journeys. Now, as a man, he claimed he could not masturbate without the use of other people’s semen. He began buying other individuals’ semen when he got out of prison (“from 30 young men in exchanges for money”) and always carried semen with him wherever he went.
The authors noted that unlike most other fetishes, the sexualisation of semen as a fetish did not occur until he was in prison (i.e., adulthood rather than childhood or adolescence). I’m not sure why (based on the evidence in the paper) but they also speculated that the man’s semen fetish was used to “overcome low self-esteem and a sense of failure” and that the fetish behaviour “occurred from a trauma caused by the bad attitude of [his] parents at an early age, and [that] such negative experiences contributed to the emergence of fetish behavior”. The paper also claimed that: “He discovered the fetish object to deal with the anger for the negative events he faced when he was in prison for ten years for armed robbery. Impulse control is likely to be impaired because of the adverse conditions created by the prison”.
They also described the man’s semen fetish as a “mental illness” (in fact, the paper seemed to imply that all fetishes are mental illnesses which is clearly not the case as most non-normative sex is non-problematic for those engaging in such behaviour). However, by diagnosing the man has having a mental illness, it meant that he was not mentally competent enough to stand trial. The paper concluded that:
“In our case, the number of [victims] is few, but [our patient is] respectively harmless to the victims and not dangerous. He cannot control his urges and behaviors. For [these] kind of cases, generally, diminished criminal responsibility is decided but for this case, it was decided that he has no criminal responsibility”.
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
BBC News (2010). Israel jails man for ‘holy semen’ sex abuse. April 26. Located at: http://news.bbc.co.uk/1/hi/world/middle_east/8644637.stm
Kuro5hin (2002). A modern craving. August 5. Located at: http://www.kuro5hin.org/story/2002/8/5/71044/01543
Taktak, S., Karakus, M., & Eke, S. M. (2015). The man whose fetish object is ejaculate: A case report. Journal of Psychiatry, 18(3), 276.
Taktak, S., Karakus, M., Kaplan, A., & Eke, S.M. (2015) Shoe fetishism and kleptomania comorbidity: A case report. European Journal of Pharmaceutical and Medical Research, 2, 14-19.
Taktak, S., Yılmaz, E., Karamustafalıoglu, O., & Unsal, A. (2016). Characteristics of paraphilics in Turkey: A retrospective study – 20 years. International Journal of Law and Psychiatry, in press.
Wikipedia (2012). Bukkake. Located at: http://en.wikipedia.org/wiki/Bukkake
Wikipedia (2012). Gokkun. Located at: http://en.wikipedia.org/wiki/Gokkun
Back in May 2014, hundreds of news outlets reported on Nintendo’s decision not to allow gamers to play as gay characters and form same-sex relationships in the life-simulation game Tomodachi Life. Understandably, there was disquiet and outrage from a number of quarters despite Nintendo’s statement that “Tomodachi Life was intended to be a whimsical and quirky game [and] not trying to provide social commentary”. Their statement at the time appeared to fan the flames rather than silence the critics.
I have been researching video game play for almost three decades and I’ve always found issues surrounding character formation, sexuality, and gender in gaming of great psychological interest. In one of our studies we found that a majority of gamers (57%) had gender-swapped their game character with female gamers (68%) being more likely to gender swap than male gamers (54%). We argued that gender swapping enabled gamers to play around and experiment with various aspects of their in-game character that are not so easy to do in real life. For others it was just fun to see if they felt any different playing a different gendered character. What makes our findings interesting is that in most instances, the gamers had the opportunity to choose the gender of their character and to develop other aspects of their character before they began to play. Choosing to gender swap may have had an effect on the gamers’ styles of play and interaction with other gamers. Whatever the reasons, it was clear from our research that the development of gamers’ online characters and avatars was important to them.
One of the reasons for the importance of online gaming identities may be because it subverts traditional parasocial interaction (PI). PI is a concept used by psychologists that has traditionally described one-sided, parasocial interpersonal relationships in situations where one individual knows a great deal about someone else, but where the other person knows little about the other (the most common being the relationship between celebrities and their fans).
A study led by Nicholas Bowman (and published in a 2012 issue of the journal Cyberpsychology, Behavior and Social Networking [CPBSN]) argued that the playing of video games challenges this concept “as the distance between game players and characters is greatly reduced, if not completely removed, in virtual environments.” The study claimed that online gaming encourages the “psychological merging of a player’s and a character’s mind” and is critical in the development of character attachment. In this context, the sexuality of a character for a player may be of fundamental psychological importance.
This appears to be confirmed in a paper by Melissa Lewis and colleagues (also published in CPBSN) who developed a scale to assess ‘character attachment’ (“the connection felt by a video game player toward a video game character”). They found that character attachment had a significant relationship with self-esteem, addiction, game enjoyment, and time spent playing games.
American researcher Dr. Adrienne Shaw has carried out a number of studies into lesbian, gay, bisexual, and transgender (LGBT) representation in video games from a cultural production perspective. She was one of the first academics in the gaming studies field to note that there was a relative lack of LGBT representation in video games. Other areas of the entertainment media (e.g., music, film, and television) appear to have much greater LGBT representation than in video games so it does beg the question of why the gaming industry appears to be behind in this respect. I recall writing a paper back in 1993 (in The Psychologist) where I argued that most video games at the time were designed by males for other males. This arguably alienated female gamers but eventually led to developers introducing strong female characters into video games (the most notable being Lara Croft in Tomb Raider). Maybe the appearance of LGBT characters and role models within games will increase over time but I’m not holding my breath.
In a more recent paper in a 2012 paper in the journal New Media and Society, Dr. Shaw claimed that the demand for minority representation in video games “often focuses on proving that members of marginalized groups are gamers” and that the gaming industry should focus on appealing to such players via targeted content. However, she argues that an individual’s identity as a gamer will intersect with “other identities like gender, race, and sexuality.” She then goes on to say that the negative connotations about being an online gamer may lead to such marginalized groups not wanting to engage in gaming. She concluded that “those invested in diversity in video games must focus their attention on the construction of the medium, and not the construction of the audience…[This] is necessary to develop arguments for representation in games that do not rely on marking groups as specific kinds of gaming markets via identifiers like gender, race, and sexuality.”
Nintendo’s decision not to allow gay relationships to form within Tomodachi Life was ill-judged, ill-informed, and outdated. Games in which identity content can be generated by its users needs to reflect the world in which the gamers’ live. In short, there should be no compromise when it comes to allowing gamers to choose their sexuality within the game.
(N.B. A version of this article first appeared in The Conversation)
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Bowman, N. D., Schultheiss, D., & Schumann, C. (2012). “I’m attached, and I’m a good guy/gal!”: how character attachment influences pro-and anti-social motivations to play massively multiplayer online role-playing games. Cyberpsychology, Behavior, and Social Networking, 15(3), 169-174
Griffiths, M.D. (1993). Are computer games bad for children? The Psychologist: Bulletin of the British Psychological Society, 6, 401-407.
Griffiths, M.D., Arcelus, J. & Bouman, W.P. (2016). Video gaming and gender dysphoria: Some case study evidence. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 34(2), 59-66.
Hussain, Z., & Griffiths, M. D. (2008). Gender swapping and socializing in cyberspace: An exploratory study. CyberPsychology and Behavior, 11(1), 47-53.
Lewis, A. & Griffiths, M.D. (2011). Confronting gender representation: A qualitative study of the experiences and motivations of female casual-gamers. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 28, 245-272.
Lewis, M. L., Weber, R., & Bowman, N. D. (2008). “They may be pixels, but they’re MY pixels:” Developing a metric of character attachment in role-playing video games. CyberPsychology and Behavior, 11(4), 515-518.
McLean, L. & Griffiths, M.D. (2013). Female gamers: A thematic analysis of their gaming experience. International Journal of Games-Based Learning, 3(3), 54-71.
Shaw, A. (2009). Putting the gay in games cultural production and GLBT content in video games. Games and Culture, 4(3), 228-253.
Shaw, A. (2012). Do you identify as a gamer? Gender, race, sexuality, and gamer identity. New Media and Society, 14(1), 28-44.
Shaw, A. (2015). Gaming at the edge: Sexuality and gender at the margins of gamer culture. Minnesota: University of Minnesota Press.
The idea for this blog was initiated when I read a snippet in The Fortean Times about a 34-year old man from New York who injected cocaine into his penis and ended up with gangrene and further medical complications. It turns out that this report was based on a letter published in a 1988 issue of the Journal of the American Medical Association by Drs. John Mahler, Samuel Perry and Bruce Sutton (and subsequently reported in a June 1988 issue of the New York Times).
The man in question came in for medical treatment following three days of priapism (i.e., prolonged and painful penile erection) and paraphimosis (i.e., foreskin in uncircumcised males can no longer be pulled over the tip of the penis). To enhance his sexual performance, he had administered cocaine directly into his urethra. After three days, both the priapism and the paraphimosis “spontaneously resolved”. However, the blood that had caused the priapism then leaked to other areas of his body over the next 12 hours (including his feet, hands, genitals, chest, and back). To stop the spread of gangrene, the medics had to partially amputate both of his legs (above the knee), and nine of his fingers. Following this, his penis also developed gangrene and fell off by itself while he was taking a bath. The exact reason for the spread of gangrene was unknown but sexologists (such as Professor John Money) speculated that it may have been because of impure cocaine being used.
When I started to search for medical literature on the topic of injecting drugs directly into male genitalia I was surprised to find quite a few papers on the topic (but unsurprisingly all case study reports given the rarity of such behaviour). One of the earliest I located was one from 1986 in the Journal of Urology by Dr. W. Somers and Dr. F. Lowe. They reported the cases of four heroin abusers with localized gangrene of the genitalia, although only one of these had actually injected heroin directly into his genitalia, in this case his scrotum and perineum (the area between the anus and the scrotum). This latter case developed more severe gangrene and was described as a “more lethal entity” than the gangrene in the other three heroin users’ genitalia.
Later, in a 1999 issue of the American Journal of Forensic Medicine and Pathology, Dr. Charles Winek and his colleagues reported the rare case of a fatality due to a male injecting heroin directly into his penis. The cause of death was determined to be due to heroin and ethanol intoxication. More recently, in a 2005 issue of the Medical Journal of the Iranian Red Crescent, Dr. Z. Ahmadinezhad and his colleagues reported a case of heroin-associated priapism. In their paper, they reported the case of a 32-year old man who was admitted to hospital following pain and swelling after injecting heroin into his penis two weeks earlier. Unfortunately, the person left the hospital following initial consultation and never came back so the outcome of the treatment provided is unknown.
In a 2011 issue of the Internet Journal of Surgery, Dr. I. Malek and colleagues reported the case of a 35-year old long-term intra-venous drug user who injected citric acid laced with heroin into the dorsal vein of his penis. This caused worsening pain and his penis developed gangrene. Over the (non-operative) treatment period, the man’s pain became worse and he had trouble urinating (so he was catheterised). Eventually, the treatment with antibiotics led to a good recovery at three-month follow-up.
Another unusual case was reported by Dr. Francois Brecheteau and his colleagues in a 2013 issue of the Journal of Sexual Medicine. They reported the successful treatment of a 26-year old male drug addict who had injected the opiate drug buprenorphine directly into the dorsal vein of his penis. After unsuccessful antibiotic treatment on its own, they then used a number of simultaneous treatments including heparin, anti-platelet drugs, antibiotics, and hyperbaric oxygen therapy, the man made a successful recovery.
Returning to cocaine rather than opiates, a case report by Dr. V. B. Mouraviev and his colleagues in a 2002 issue of the Scandinavian Journal of Urology and Nephrology reported the case of a 31-year-old Canadian man who had injected cocaine directly into his penis. He turned up at the emergency having endured penile pain for 22 hours following the injection. Twelve hours after injecting the cocaine, the man noticed swelling and bruising starting to appear on the right side of his penis where he had made the injection. As a consequence, his penis developed gangrene (“localized death and decomposition of body tissue, resulting from obstructed circulation or bacterial infection”) most probably from bacterial infection via the injection. He had to undergo reconstructive skin graft surgery and was given antibiotics. In this particular case, the treatment was successful. Other similar reports of medical complications (usually gangrene) following the injection of cocaine into the penis have since appeared in a number of papers including a 2013 paper by Dr. Fahd Khan and colleagues in the Journal of Sexual Medicine.
Cocaine and heroin aren’t the only recreational drugs to have been injected into male genitalia. A paper in a 2014 issue of Urology Case Reports by Dr. Cindy Garcia and her colleagues reported the case of a 45-year-old male intravenous drug user who developed an abscess after he injected amphetamine into his penis. The man chose a penile vein after being unable to find any other suitable peripheral vein. He was treated with intravenous antibiotics and had to have his abscess drained via a penile incision. Within a month he had been all but successfully treated. In their paper (which also included a review of the literature on penile abscesses), they concluded that:
“Penile abscesses are an uncommon condition. There are multiple aetiologies of penile abscesses, including penile injection, penile trauma, and disseminated infection. Penile abscesses might also occur in the absence of an underlying cause. The treatment of penile abscesses should depend on the extent of infection and the cause of the abscess. Most cases of penile abscess necessitate surgical debridement [removal of dead or infected tissue]”.
Similarly, in a 2015 issue of Case Reports in Urology, Dr. Thomas W. Gaither and his colleagues reported two cases of men who had injected metamphetamine into their penis. The first case was a 47-year-old gay man who had a history of “methamphetamine use, prior penile abscesses, urethral foreign body insertions, HIV, hepatitis C, and diabetes mellitus”. He attended the hospital emergency department suffering from severe penile pain and scrotal swelling having injected methamphetamine into the shaft of his penis a few days before. On the same day that he went to the emergency department he was immediately taken into the operating room where an incision was made in his penis, and the abscess was drained of its “purulent foul-smelling fluid” and washed out with saline solution. The second case was a 33-year-old heterosexual male with no previous medical history (apart from a history of depression) turned up at the hospital emergency department with acute penile pain, a day after he had injected methamphetamine directly into his penis. Again, he was immediately taken to the operating room where his penile abscess was drained after an incision. Neither of the cases involved any penile gangrene and both men were also given antibiotics to treat the infected area. In both cases, the authors speculated that the abscesses formed as a result of direct contamination from repeated penile injections.
Finally, Dr. Lucas Prado and his colleagues reported a case study in a 2012 issue of the Journal of Andrology of a 31-year-old man who was admitted to the emergency department after he had injected 10ml of methadone into his penis in an attempt to commit suicide (the first case of penile methadone injection). The man had a 15-year history of drug abuse over the past year and had attempted a drug-related suicide three times. This particular suicide attempt led to acute liver and renal failure as well as erectile dysfunction. Although the man survived, ten months after the suicide attempt, the man still had complete erectile dysfunction.
Although I didn’t do a systematic review of all the literature, it is clear that the injection of recreational drugs directly into male genitalia appears to be relatively rare although all the literature I located was based on those who end up seeking treatment for when things go horribly wrong. There could of course be many hundreds or thousands of people out there that have engaged in such practices but don’t end up in a hospital emergency ward. However, I certainly wouldn’t recommend such a practice to anyone.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Ahmadinezhad, Z., Jabbari, B.H., Saberi, H., Khaledi, F., & Safavi, F. (2005). Heroin associated priapism. Medical Journal of the Iranian Red Crescent, 7(3), 67-68.
Brecheteau, F., Grison, P., Abraham, P., Lebdai, S., Kemgang, S., Souday, V., … & Bigot, P. (2013). Successful medical treatment of glans ischemia after voluntary buprenorphine injection. Journal of Sexual Medicine, 10(11), 2866-2870.
Cunningham, D.L., & Persky, L. (1989). Penile ecthyma gangrenosum: Complication of drug addiction. Urology, 34(2), 109-110.
Gaither, T.W., Osterberg, E.C., Awad, M. A., & Breyer, B.N. (2015). Surgical intervention for penile methamphetamine injections. Case Reports in Urology, 467683, doi.org/10.1155/2015/467683
Garcia, C., Winter, M., Chalasani, V., & Dean, T. (2014). Penile abscess: a case report and review of literature. Urology Case Reports, 2(1), 17-19.
Khan, F., Mukhtar, S., Anjum, F., Tripathi, B., Sriprasad, S., Dickinson, I. K., & Madaan, S. (2013). Fournier’s gangrene associated with intradermal injection of cocaine. Journal of Sexual Medicine, 10(4), 1184-1186.
Malek, I., Parmar, C., McCabe, J., & Irwin, P. (2011). Successful non-operative management of penile wet gangrene following self-injection of heroin in dorsal vein of penis. Internet Journal of Surgery, 11(1), 1-3.
Mireku-Boateng, A.O., & Tasie, B. (2001). Priapism associated with intracavernosal injection of cocaine. Urologia Internationalis, 67(1), 109-110.
Mouraviev, V. B., Pautler, S. E., & Hayman, W. P. (2002). Fournier’s gangrene following penile self-injection with cocaine. Scandinavian Journal of Urology and Nephrology, 36(4), 317-318.
Munarriz, R., Hwang, J., Goldstein, I., Traish, A.M., & Kim, N.N. (2003). Cocaine and ephedrine-induced priapism: case reports and investigation of potential adrenergic mechanisms. Urology, 62(1), 187-192.
Prado, L. G., Huber, J., Huber, C. G., Mogler, C., Ehrenheim, J., Nyarangi‐Dix, J., … & Hohenfellner, M. (2012). Penile methadone injection in suicidal intent: Life‐threatening and fatal for erectile function. Journal of Andrology, 33(5), 801-804.
Singh, V., Sinha, R. J., & Sankhwar, S. N. (2011). Penile gangrene: A devastating and lethal entity. Saudi Journal of Kidney Diseases and Transplantation, 22(2), 359.
Somers, W.J., & Lowe, F.C. (1986). Localized gangrene of the scrotum and penis: A complication of heroin injection into the femoral vessels. Journal of Urology, 136, 111-113.
Winek, C. L., Wahba, W. W., & Rozin, L. (1999). Heroin fatality due to penile injection. American Journal of Forensic Medicine and Pathology, 20(1), 90-92.
Those that know me well often comment that I have a general inability to sit still and that I am a ‘fidget’. (This is not necessarily a bad thing and in fact there are some positives to fidgeting that I outlined in a previous blog on bad behaviours that are sometimes good for you). There is certainly some truth to the observation that I fidget but sometimes the fidgeting is out of my control. Every few weeks my right lower leg appears to take on a life of its own and I will get strange (uncomfortable) sensations (such as tingling, itching, and aching, and occasionally cramp-like feelings) that force me to move my right leg and foot around. It only happens when I am in a resting and relaxing state and usually lasts about 30 minutes (but can occasionally last much longer). On occasions it disrupts my work and sleep but I find that just getting up and moving around is sometimes enough to alleviate the uncomfortable feelings.
A few years ago I Googled my ‘symptoms’ and was surprised to find that I am not the only person who appears to experience such effects and that there is a whole medical literature on what has been termed ‘restless legs syndrome’ although in my case it would be in a singular rather than plural form). I’ve had the condition for about 15 years now and it may be related to some of the medication I take for an unrelated chronic degenerative health condition that I have. According to the Wikipedia entry on restless legs syndrome (RLS):
“The first known medical description of RLS was by Sir Thomas Willis in 1672. Willis emphasized the sleep disruption and limb movements experienced by people with RLS…The term ‘fidgets in the legs’ has also been used as early as the early nineteenth century. Subsequently, other descriptions of RLS were published, including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim (1923) and Frederick Gerard Allison (1943). However, it was not until almost three centuries after Willis, in 1945, that Karl-Axel Ekbom (1907–1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, Restless legs: clinical study of hitherto overlooked disease. Ekbom coined the term “restless legs” and continued work on this disorder throughout his career. He described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, relation to anemia, and common occurrence during pregnancy. Ekbom’s work was largely ignored until it was rediscovered by Arthur S. Walters and Wayne A. Hening in the 1980s. Subsequent landmark publications include 1995 and 2003 papers, which revised and updated the diagnostic criteria”.
As well as being referred to as RLS, it is sometimes referred to as Willis-Ekbom Disease or Willis-Ekbom Syndrome. Since being ‘rediscovered’ in the 1980s, there have been a lot of scientific papers published on the phenomenon although many of these are medical case studies (I don’t think my own experiences are extreme enough or strong enough to appear in any medical textbook. The Wikipedia entry on RLS provides a good summary of what is known medically and empirically:
“Restless legs syndrome (RLS) is a disorder that causes a strong urge to move one’s legs. There is often an unpleasant feeling in the legs that improves somewhat with moving them. Occasionally the arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep. Risk factors for RLS include low iron levels, kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, and pregnancy. A number of medications may also trigger the disorder including antidepressants, antipsychotics, antihistamines, and calcium channel blockers. There are two main types. One is early onset RLS which starts before age 45 [years], runs in families and worsens over time. The other is late onset RLS which begins after age 45 [years], starts suddenly, and does not worsen. Diagnosis is generally based on a person’s symptoms after ruling out other potential causes… Females are more commonly affected than males and it becomes more common with age…Some doctors express the view that the incidence of restless leg syndrome is exaggerated by manufacturers of drugs used to treat it. Others believe it is an under-recognized and undertreated disorder…An association has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorder. Both conditions appear to have links to dysfunctions related to the neurotransmitter dopamine, and common medications for both conditions among other systems, affect dopamine levels in the brain”.
According to a review by Dr. Richard Allen and Dr. Christopher Earley in the Journal of Clinical Neurophysiology, RLS affects 2.5-15% of the US population. In another review on sleep disorder in the journal American Family Physician, Dr. Kannan Ramar and Dr. Eric Olson reported that RLS is typically characterized by four essential features: These are:
“(1) the intense urge to move the legs, usually accompanied or caused by uncomfortable sensations (e.g., “creepy crawly,” aching) in the legs; (2) symptoms that begin or worsen during periods of rest or inactivity; (3) symptoms that are partially or totally relieved by movements such as walking or stretching; and (4) symptoms that are worse or only occur in the evening or at night”.
Various online articles and papers report a variety of potential treatments based on the notion that RLS might be caused by a dopamine imbalance in the body. Some medics advise a regular sleep routine (such as that advised for those with insomnia), and cutting out the drinking of alcohol and the smoking of cigarettes. Pharmacological treatments include the use of drugs that are also used in the treatment of Parkinson’s disease such as L-DOPA and pramipexole, and the use of magnesium sulphate therapy (as reported in a 2006 paper in the Journal of Clinical Sleep Medicine – magnesium is known to be a natural muscle relaxant). In a 2011 issue of the journal Sleep Medicine, In an online article about RLS, Dr Michael Platt, author of the 2014 book Adrenalin Dominance, claims that RLS sufferers can be treated using a progesterone cream:
“Excess adrenalin during the night can cause restless leg syndrome. People often have associated symptoms also resulting from elevated adrenalin, such as teeth grinding, the need to urinate, and tossing and turning, and they often awaken in the morning with low back pain. Characteristically, RLS patients have an excess of adrenaline, may toss and turn all night, be quick to anger, might be workaholics, will usually have fibromyalgia (aches and pains – low back, side of the hips, and grind their teeth), they might drink too much, and will be hypoglycemic (sleepy between 3-4 p.m. or when in a car), and so on. There is an associated over-production of insulin and an under-production of progesterone…[By using a progesterone cream] I have had 100% success with eliminating RLS by getting hormones into balance, often within the first week. Patients feel more relaxed, they can sleep at night, rage disappears, and they can focus more easily”.
Dr. Luis Marin and his colleagues reported a different treatment for RLS altogether. They reported the case of a 41-year-old male RLS sufferer who after being on medication for RLS discovered his own solution – having sex. Following sex, the man reported that all RLS symptoms would disappear. Marin and colleagues speculated that the release of dopamine following orgasm might alleviate RLS symptoms. This appears to be a reasonable speculation given the findings of research published in the Journal of Neuroscience by Dr. Gert Holstege and his colleagues who examined brain activation at the point of ejaculation. In their paper they reported the similarity between ejaculation and using heroin in terms of brain activation:
“We used positron emission tomography to measure increases in regional cerebral blood flow during ejaculation compared with sexual stimulation in heterosexual male volunteers. Manual penile stimulation was performed by the volunteer’s female partner. Primary activation was found in the mesodiencephalic transition zone, including the ventral tegmental area, which is involved in a wide variety of rewarding behaviors. Parallels are drawn between ejaculation and heroin rush”.
It could well be that the increase in dopamine following ejaculation acts in a similar way to the medications that are given to RLS sufferers. Of all the treatments for RLS that I have read about, I think I know which one I would prefer!
Allen, R.P., & Earley, C.J. (2001). Restless legs syndrome: A review of clinical and pathophysiologic features. Journal of Clinical Neurophysiology, 18(2), 128-147.
Bartell S1, Zallek S. Intravenous magnesium sulfate may relieve restless legs syndrome in pregnancy. Journal of Clinical Sleep Medicine, 15, 187-188.
Chaudhuri, K.R., Appiah-Kubi, L.S., & Trenkwalder, C. (2001). Restless legs syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 71(2), 143-146.
Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of Internal Medicine, 266(5), 419-431.
Holstege, G., Georgiadis, J. R., Paans, A. M., Meiners, L. C., van der Graaf, F. H., & Reinders, A. S. (2003). Brain activation during human male ejaculation. Journal of Neuroscience, 23(27), 9185-9193
Leschziner, G., & Gringras, P. (2012). Restless legs syndrome. British Medical Journal, 344, e3056.
Marin, L.F., Felicio, A.C., & Prado, G.F. (2011). Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome? Sleep Medicine, 12(4), 422.
Ondo, W. G. (2009). Restless legs syndrome. Neurologic Clinics, 27(3), 779-799.
Ramar, K; Olson, EJ (Aug 15, 2013). Management of common sleep disorders. American Family Physician, 88, 231–238.
Satija, P., & Ondo, W. G. (2008). Restless legs syndrome. CNS Drugs, 22(6), 497-518.