Bottling it up: A brief look at penile strangulation

While I was researching a blog on urethral manipulation I came across a paper entitled ‘Penile strangulation by a hard plastic bottle’ by Dr. Satish Jain and his colleagues published in a 2004 issue of the Indian Journal of Surgery. As the paper explains:

“Penile strangulation is a rare injury and most require only removal of the constriction and conservative management. Penile strangulating objects are usually rings, nuts, bottles, bushes, wedding rings etc. in an adult, while in children they tend to be rubber bands threads or hair coils. In adults these constricting penile bands, whether expandable or non-expandable, are placed deliberately by the person himself for masturbation or by the female counterpart to prolong erection. In children these are used to prevent enuresis and incontinence or as an innocent childish experiment. Because these bands occlude penile venous flow, most patients present to the emergency with penile edema” [an edema is a swelling caused by fluid in body tissue].

They reported the case of a 27-year old man who turned up at hospital needing emergency treatment for an extremely swollen penis and unable to urinate. This occurred as a result of placing his penis inside a hard plastic bottle as a masturbatory aid. In short, the neck of the bottle got stuck, constricting the penis base. The paper then described how the bottle was removed:

“The hospital carpenter was called to assist in cutting open that bottle. With the use of iron cutting saw…first the bottle was cut near the neck and then the bottle neck was cut open slowly and diagonally. The penis was held slightly bent downwards. Once one end of the bottle neck was cut open, the plaster spreader (used by orthopaedician) was use to hold the cut ends open and the whole bottle neck was cut opened and removed after 15 minutes of struggle…Penile edema subsided completely in a week and patient had an uneventful recovery. There was no erectile dysfunction or decreased uroflow”.

This case was relatively easy to treat and on the less serious side. Later in the paper, the authors note that more serious medical complaints can arise including ulceration (skin inflammation and/or lesion), necrosis (death of body tissue), urinary fistula (abnormal opening of the urethra) or even gangrene (death and decay of body tissue due to loss of blood supply). Unsurprisingly, these latter conditions most often occur because the patient is too shy or embarrassed to seek medical help.

It was after reading this paper that I went searching for other cases and found many papers on the topic (far too many to outline here). However, I thought I would pick out some that caught my eye. Penises stuck inside bottles seemed (somewhat predictably) to feature quite heavily. For instance, Dr. C.K. Ooi and colleagues reported two cases of “unusual” penile strangulation in a 2009 issue of the Singapore Medical Journal. One of the cases was a 77-year old man who got his penis stuck in a bottle. Although the bottle was successfully removed in the emergency ward the patient subsequently developed post-obstructive diuresis (i.e., excessive urination). The second case was a 60-year old man who got his penis stuck inside a metallic ring. An orthopaedic cutter was used to remove the ring and there were no long-term complications. Another paper by Dr. Matthias May and colleagues in a 2006 issue of the International Urology and Nephrology reported the case of a 49-year old man who got his penis stuck in a polyethylene terephthalate (PET) bottle. (Ethylene terephthalate is a light plastic material that is – according to various papers I read – “nearly indestructible”). After trying to cut the bottle off with a scalpel and then a glass saw, the bottle was finally removed by cutting it longitudinally with an oscillating saw (that was normally used for cutting off patient plaster casts).

A more recent case in a 2011 issue of the International Journal of Biological and Medical Research by Dr. Uday Shamrao Kumbhar and colleagues reported the case of a 46-year old man who got a plastic bottle neck stuck on the base of his penis following attempted masturbation. More specifically, they reported that:

“The man came after 14 [hours] with gross penile edema and impaired penile sensation distal to the constriction…The nature of the plastic bottle neck was such that an attempt at cutting the device was difficult. We retrieved the constructing device by cutting it by soldering gun (used for electrical soldering by electrician). Cuts were taken at two places – 3 and 9 o’clock positions. The only hurdle was heat generated during the soldering, which was overcome by intermittent soldering and pouring cold normal saline in between”.

The patient recovered fully and following removal had a normal erection, could masturbate and have sex without problems. The most recent case I came across was published in a 2014 issue of Case Reports in Urology. The authors (Dr. Avinash Chennamsetty, Dr. David Wenzler and Dr. Melissa Fischer) reported the case of a 49-year-old man that turned up at the Emergency Department complaining that his penis was swollen and painful. The authors reported that nine days prior to coming into hospital the man had placed a metallic constriction device over his penis for an “autoerotic motive” but then found that he couldn’t remove it. The authors noted that:

“He was able to urinate but had a decreased force of stream. Physical exam revealed a tightly encircling metallic ring with peripheral cogs placed on the mid shaft of the penis causing severe penile engorgement and edema. The metal appeared to be a very hard alloy with thickness measuring 5–7mm depending on the location. The penile skin under the ring was excoriated and necrotic. Due to the incarceration time, degree of necrosis, and significant distal edema, simple lubrication, compression, and manual removal were not an option for fear of amputation. Manual and electric ring cutters were used, but after several attempts, we were unable to do more than scratch the surface of the metal ring. The patient was given procedural sedation and a tongue depressor was placed beneath the metal ring to provide soft tissue protection. Using the pin cutter, enough force was generated in one attempt to snap the ring into two separate pieces”.

Another different kind of penile strangulation – with more serious consequences – was reported by Dr. A. Nuhu and his colleagues in a 2009 issue of the West African Journal of Medicine. In this instance, a middle-aged Nigerian managed to get a round metallic nut stuck on his penis. For five days the man had delayed coming into hospital for treatment even though he was unable to urinate properly (in fact he had trouble urinating at all). By the time he went for medical help, his penis had developed gangrene. Unfortunately, the only treatment option available was a complete amputation of his penis.

It is also worth mentioning that a number of papers I came across purely describe the methods that can be used in the “extrication of penile entrapment” such as a detailed report by Dr. Guang-Ming Liu and colleagues in a 2012 issue of the International Urology and Nephrology that described the “technique of suture traction in conjunction with Dundee…performed for the management of penile entrapment in polyethylene terephthalate bottle neck” that they claim can be performed “without any special tools required in the management of penile entrapment involving PET bottles [and can] be applied safely for the low-grade penile injury”.

Within two weeks of removal, the man’s penis had fully recovered and he was able to resume sexual activity. Another earlier 2001 paper by Dr. Mark Detweiler in the Scandinavian Journal of Urology and Nephrology outlined treatment guidelines “according to level of penile trauma for penile incarceration by metal devices”. Detweiler analysed all previous cases of penile strangulation (aka penile incarceration) and divided treatment interventions into four groups going from the safest to the most dangerous to perform: (i) string techniques with and without aspiration [removal] of blood from the glans; (ii) pure aspiration techniques; (iii) cutting devices; and (iv) surgical techniques.

Finally, the most tragic case of penile strangulation I came across was one published in 2011 by Dr. Benito Morentin and colleagues in the American Journal of Forensic Medicine and Pathology. They reported that a 58-year old man was found dead at a guesthouse by a flatmate living in the house. The paper reported: 

“According to the flatmate, the deceased had not been out of his room in the last 2 weeks. Two days before the death the flatmate phoned the emergency services asking for help due to the strange behavior of the subject. When the emergency staff arrived the man refused any kind of help claiming that he did not have any medical problems at all. Clinical antecedents included paresis of the left leg due to stroke, smoking, alcoholism, and social behavior disorder. At autopsy, physical examination showed that the penis was engorged and swollen, with dark black color and evident gangrene. A plastic bottle neck was found over the base of the penis. Between the bottle neck and the penis there was a piece of condom…Histologic examination of the penis revealed severe necrosis, intense hemorrhage of the tissue due to stagnated blood, and thrombosis… Death was attributed to multi-organ failure secondary to septic shock”.

This last case is clearly an extreme and tragic case. The authors speculated that the man was simply too ashamed to seek treatment. They also believed that this is the only ever death recorded as arising from penile strangulation.

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

Further reading

Chennamsetty, A., Wenzler, D. & Fischer, M. (2014). Removal of a penile constriction device with a large orthopedic pin cutter. Case Reports in Urology, Volume 2014, http://dx.doi.org/10.1155/2014/347285

Detweiler, M. B. (2001). Penile incarceration with Metal objects a review of procedure choice based on penile trauma grade. Scandinavian Journal of Urology and Nephrology, 35(3), 212-217.

Ivanovski, O., Stankov, O., Kuzmanoski, M., Saidi, S., Banev, S., Filipovski, V., Lekovski, L. & Popov, Z. (2007). Penile strangulation: two case reports and review of the literature. Journal of Sexual Medicine, 4(6), 1775-1780.

Jain S., Gupta A., Singh T., Aggarwal N., Sharma, S. & Jain S. (2004). Penile strangulation by a hard plastic bottle: A case report, Indian Journal of Surgery, 66(3), 173-175.

Liu, G. M., Sun, G., & Ma, H. S. (2012). Extrication of penile entrapment in a polyethylene terephthalate (PET) bottle: A technique of suture traction and Dundee and literature review. International Urology and Nephrology, 44(5), 1335-1340.

May, M., Gunia, S., Helke, C., Kheyri, R., & Hoschke, B. (2006). Penile entrapment in a plastic bottle – A case for using an oscillating splint saw. International Urology and Nephrology, 38(1), 93-95.

Morentin B., Biritxinaga B. & Crespo L. (2011). Penile strangulation: Report of a fatal case. American Journal of Forensic Medicine and Pathology, 32, 344-346.

Nuhu, A., Edino, S. T., Agbese, G. O., & Kallamu, M. (2009). Penile gangrene due to strangulation by a metallic nut: a case report. West African Journal of Medicine, 28(5), 340-242.

Ooi, C. K., Goh, H. K., Chong, K. T., & Lim, G. H. (2009). Penile strangulation: report of two unusual cases. Singapore Medical Journal, 50(2), e50-52.

Shamrao Kumbhar U., Dasharathimurumu, D. & Bhargavpak, D. (2011). Acute penile incarceration injury caused by a plastic bottle neck. International Journal of Biological and Medical Research, 2(4), 1184-1185.

Blog-nitive psychology: 500 articles and counting

It’s hard for me to believe that this is the 500th article that I have published on my personal blog. It’s also the shortest. I apologise that it is not about any particular topic but a brief look back at what my readers access when they come across my site. (Regular readers might recall I did the same thing back in October 2012 in an article I wrote called ‘Google surf: What does the search for sex online say about someone?’). As of August 26 (2014), my blog had 1,788,932 visitors and is something I am very proud of (as I am now averaging around 3,500 visitors a day). As I write this blog, my most looked at page is my blog’s home page (256,262 visitors) but as that changes every few days this doesn’t really tell me anything about people like to access on my site.

Below is a list of all the blogs that I have written that have had over 10,000 visitors (and just happens to be 25 articles exactly).

• Coprophilia (40,001)
• Urophilia (38,933)
• Somnophilia (22,291)
• Trampling fetishes (20,651)
• Urethral manipulation (20,234)
• Scrotal infusion (20,041)
• Genital bisection (18,715)
• Felching (18,193)
• Vorarephilia (16,566)
• Insect sting fetishes (16,236)
• Transformation fetishes (15,731)
• Amputee fetishes (15,467)
• Macrophilia (15,322)
• Sexual masochism (13,937)
• Formicophilia (13,655)
• Eproctophilia (13,295)
• Lactophilia (12,656)
• Equinophilia (12,434)
• Spit fetishes (12,259)
• Menophilia (11,855)
• Paraphilic infantilism (11,590)
• Zoophilia (11,235)
• Transvestic fetishism (10,661)
• Forniphilia (10,046)
• Necrophilia (10,020)

The first thing that struck me about my most read about articles is that they all concern sexual fetishes and paraphilias (in fact the top 30 all concern sexual fetishes and paraphilias – the 31st most read article is one on coprophagia [7,250 views] with my article on excessive nose picking being the 33rd most read [6,745 views]). This obviously reflects either (a) what people want to read about, and/or (b) reflect issues that people have in their own lives.

I’ve had at least five emails from readers who have written me saying (words to the effect of) “Why can’t you write what you are supposed to write about (i.e., gambling)?” to which I reply that although I am a Professor of Gambling Studies, I widely research in other areas of addictive behaviour. I simply write about the extremes of human behaviour and things that I find of interest. (In fact, only one article on gambling that I have written is in the top 100 most read articles and that was on gambling personality [3,050 views]). If other people find them of interest, that’s even better. However, I am sometimes guided by my readers, and a small but significant minority of the blogs I have written have actually been suggested by emails I have received (my blogs on extreme couponing, IVF addiction, loom bands, ornithophilia, condom snorting, and haircut fetishes come to mind).

Given this is my 500th article in my personal blog, it won’t come as any surprise to know that I take my blogging seriously (in fact I have written academic articles on the benefits of blogging and using blogs to collect research data [see ‘Further reading’ below] and also written an article on ‘addictive blogging’!). Additionally (if you didn’t already know), I also have a regular blog column on the Psychology Today website (‘In Excess’), as well as regular blogging for The Independent newspaper, The Conversation, GamaSutra, and Rehabs.com. If there was a 12-step ‘Blogaholics Anonymous’ I might even be the first member.

“My name is Mark and I am a compulsive blogger”

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

Further reading

Griffiths, M.D. (2012). Blog eat blog: Can blogging be addictive? April 23. Located at: https://drmarkgriffiths.wordpress.com/2012/04/20/blog-eat-blog-can-blogging-be-addictive/

Griffiths, M.D. (2012). Stats entertainment: A review of my 2012 blogs. December 31. Located at: https://drmarkgriffiths.wordpress.com/2012/12/31/stats-entertainment-a-review-of-my-2012-blogs/

Griffiths, M.D. (2013). How writing blogs can help your academic career. Psy-PAG Quarterly, 87, 39-40.

Griffiths, M.D. (2013). Stats entertainment (Part 2): A 2013 review of my personal blog. December 31. Located at: https://drmarkgriffiths.wordpress.com/2013/12/31/stats-entertainment-part-2-a-2013-review-of-my-personal-blog/

Griffiths, M.D. (2014). Top tips on…Writing blogs. Psy-PAG Quarterly, 90, 13-14.

Griffiths, M.D. (2014). Blogging the limelight: A personal account of the benefit of excessive blogging. May 8. Located at: https://drmarkgriffiths.wordpress.com/2014/05/08/blogging-the-limelight-a-personal-account-of-the-benefits-of-excessive-blogging/

Griffiths, M.D., Lewis, A., Ortiz de Gortari, A.B. & Kuss, D.J. (2014). Online forums and blogs: A new and innovative methodology for data collection. Studia Psychologica, in press.

Urine for a treat: A brief overview of catheterophilia

In a previous blog, I examined medical fetishism (i.e., those individuals that derive sexual pleasure and arousal from medical procedures and/or something medically related). Maddy’s Mansion features a small article on medical fetishism and is a little more wide ranging in scope:

“Medical fetishism refers to a collection of sexual fetishes for objects, practices, environments, and situations of a medical or clinical nature. This may include the sexual attraction to medical practitioners, medical uniforms, surgery, anaesthesia or intimate examinations such as rectal examination, gynecological examination, urological examination, andrological examination, rectal temperature taking, catheterization, diapering, enemas, injections, the insertion of suppositories, menstrual cups and prostatic massage; or medical devices such as orthopedic casts and orthopedic braces. Also, the field of dentistry and objects such as dental braces, retainers or headgear, and medical gags. Within BDSM [bondage, domination, submission, sadomasochism] culture, a medical scene is a term used to describe the form of role-play in which specific or general medical fetishes are pandered to in an individual or acted out between partners”.

As is obvious from the description above, one very specific sub-type of medical fetishism is catheterophilia. Both Dr. Anil Aggrawal (in his book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices) and Dr. Brenda Love (in her Encyclopedia of Unusual Sex Practices) define catheterophilia as sexual arousal from use of catheters. The Right Diagnosis website goes a little further and reports that catheterophilia can include one or more of the following: (i) sexual interest in using a catheter, (ii) abnormal amount of time spent thinking about using a catheter, (iii) recurring intense sexual fantasies involving using a catheter, (iv) recurring intense sexual urges involving using a catheter, and (v) sexual preference for using a catheter.

Not only is catheterophilia a sub-type of medical fetishism but is also a sub-type of urethralism (that I also covered in a previous blog). Catheterophilia may also share some overlaps with other sexual paraphilias such as paraphilic infantilism (i.e., deriving sexual pleasure and arousal from pretending to be an adult baby). Dr. G. Pranzarone in his Dictionary of Sexology (and relying heavily on Professor John Money’s seminal 1986 book Lovemaps) defines urethralism as:

“The condition or activity of achieving sexuoerotic arousal through stimulation of the urinary urethra by means of insertions of rubber cathethers, rods, objects, fluids, ballbearings, and even long flexible cathether-like electrodes (“sparklers”). This activity may be part of a paraphilic rubber catheter fetish, a sadomasochistic repertory, sexuoerotic experimentation and variety, or activity the result of anatomic ignorance as urethral intercourse has been described wherein a case of infertility was due to the insertion of the husband’s penis into the wife’s urethra rather than the vagina”.

Pranzarone also provides a little information on catheterophilia, and notes that it is a sexual paraphilia of the “fetishistic and talismanic type in which the sexual arousal and facilitation or attainment of orgasm are responsive to and contingent on having a catheter inserted up into the urethra”. Catheterization is nothing new and according to Dr. Brenda Love has been practiced for at least 4000 years. She also provided a lengthy entry in her sexual encyclopedia although most of it is devoted to describing different types of catheters. However, her perspective on catheter use is related more to sexual masochism and sexual sadism. More specifically, she claims that:

“Catheters are used in sex play as a symbol of total control over a partner. This type of sex play is similar to the catheterization found in health care facilities. The sterilized catheter is inserted up through the urethra and into the bladder which allows the flow of urine to be controlled by the dominant partner. The stimulation seems to trigger the brain’s pleasure center that ordinarily responds to urination or ejaculation…the urethra is often sore and burns for half an hour afterward”

Apart from definitions of catheterophilia, and short summaries that the condition exists, there has been little in the way of academic or clinical research. I couldn’t even find a single case study. A Finnish study led by Dr Laurence Alison reported in a 2001 issue of the Archives of Sexual Behavior reported that enduring the insertion of a catheter was one of the activities engaged in by sadomasochists, particularly those involved in ‘hyper-masculine pain administration’. Other associated activities by this group of practitioners included rimming, dildo use, cock binding, being urinated upon, being given an enema, fisting, and being defecated upon. Gay men were more likely than heterosexuals to engage in these types of activity.

In 2002, the same team, this time led by Dr. Kenneth Sandnabba examined the sexual behaviour of sadomasochists in the journal Sexual and Relationship Therapy. The paper summarized the results from five empirical studies of a sample of 184 Finnish sadomasochists (22 women and 162 men). More specifically, the examined the frequency with which the respondents engaged in different sexual practices, behaviours and role-plays during the preceding 12 months and reported that 9.2% had used catheters as part of the sexual activities.

In a previous blog on fetishism, I wrote at length about a study led by Dr G. Scorolli (University of Bologna, Italy) on the relative prevalence of different fetishes using online fetish forum data. It was estimated (very conservatively in the authors’ opinion), that their sample size comprised at least 5000 fetishists (but was likely to be a lot more). Their results showed that there were 28 fetishists (less than 1% of all fetishists) with a sexual interest in catheters.

When I published my previous blog on urethralism, one reader wrote to me with an example of urethral stimulation via catheter use. Obviously, I have no idea to the extent of such practices and how typical this experience is, but I thought I would share it with you nonetheless:

“I have read a patient’s experiences of catheter insertions. He said his first one was excruciating and subsequent insertions became less and less bothersome. Nurses state that some men [say] the Foley catheter does not bother them at all. From common sense I see that there is callousing happening from urethra trauma (especially the first insertion. [This is a] compelling reason why patients should always have a condom catheter, and the Foley catheter used only when necessary. I am most concerned with the permanent nerve damage the very nerves that are also needed for optimum orgasmic intensity”.

The Right Diagnosis website claims that treatment for catheterophilia is generally not sought unless the condition becomes problematic for the person in some way and they feel compelled to address their condition. The site also claims that the majority of catheterophiles learn to accept their fetish and manage to achieve gratification in an appropriate manner.

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

Further reading

Alison, L., Santtila, P., Sandnabba, N. K., & Nordling, N. (2001). Sadomasochistically oriented behavior: Diversity in practice and meaning. Archives of Sexual Behavior, 30, 1–12.

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

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

Maddy’s Mansion (2010). Catheterophilia. October 4. Located at: http://maddysmansion.blogspot.co.uk/2010/10/catheterophilia.html?zx=b5754ebdc388557b

Money, J. (1986). Lovemaps: Clinical Concepts of Sexual/Erotic Health and Pathology, Paraphilia, and Gender Transposition of Childhood, Adolescence, and Maturity. New York: Irvington Publishers.

Pranzarone, G.F. (2000). The Dictionary of Sexology. Located at: http://ebookee.org/Dictionary-of-Sexology-EN_997360.html

Right Diagnosis (2012). Catheterophilia. February 1. Located at: http://www.rightdiagnosis.com/c/catheterophilia/intro.htm

Sandnabba, N.K., Santtila, P., Alison, L., & Nordling, N. (2002). Demographics, sexual behaviour, family background and abuse experiences of practitioners of sadomasochistic sex: A review of recent research. Sexual and Relationship Therapy, 17, 39–55.

Scorolli, C., Ghirlanda, S., Enquist, M., Zattoni, S. & Jannini, E.A. (2007). Relative prevalence of different fetishes. International Journal of Impotence Research, 19, 432-437.

Bottoms up! An overview of rectal foreign bodies

In a previous blog I looked at the practice of urethral manipulation where men insert objects into their urethra for sexual stimulation. Another similar sexual practice is the insertion of ‘foreign bodies’ into the rectal passage. Most of what is known academically and clinically is from people (almost always male) who turn up to hospital emergency department requiring treatment (i.e., removal of the foreign object that has become trapped inside their rectum). A 2010 review by Dr. Joel Goldberg and Dr. Scott Steele in the Surgical Clinics of North America noted that “retained rectal foreign bodies have been reported in patients of all ages, genders, and ethnicities, more than two-thirds of patients with rectal bodies are men in their 30s and 40s”.

There are dozens and dozens of papers on the topic of rectal foreign bodies and the list of objects and items that have been removed by doctors is almost as long as the number of papers and includes (but not restricted to): vegetables (e.g., potatoes, cucumbers, carrots, turnips, onions), fruit (e.g., bananas, apples), other foodstuffs (e.g., salami, hard boiled eggs), food and drink containers (e.g., glass bottles, plastic bottles, peanut butter jars, glass tumblers), sporting items (e.g., baseballs, tennis balls), household and kitchen objects (e.g., candles, light bulbs, broomstick handle, spatulas, mortar pestle), sex toys (e.g., vibrators, dildos), and improvised objects (e.g., a sand-filled bicycle inner tubing, plastic fist and forearm, shoehorn, axe handles, aluminium money tube, whip handles, soldering irons, glass tubes, frozen pigs tail). Some of these can become very dangerous (e.g., light bulbs that break with broken glass bits causing perforation of the rectum and/or colon), and in one case reported in the American Journal of Surgery led to peritonitis. Despite the many published case studies, there are no estimates of the incidence of rectal foreign body insertion among the population as almost all that is known is only based on the people that end up seeking medical intervention.

Many of the people seeking treatment are gay men although some of the literature features females who have been rectally assaulted. Object removal by the medical team can sometimes be difficult. For instance, one case in the American Journal of Proctology described an instance where a light bulb was lodged in the rectal cavity and the medical team had to improvise to remove the foreign body. They had to attach a light bulb socket to the end of a stick, insert the ‘homemade’ devise into the patient’s rectum, screw the socket onto the lodged light bulb, and then pull it out the same way as it went in. In the same paper, the authors described how they removed a glass tumbler from one man. Here, they managed to pour molten plaster into the tumbler along with some rope placed into the molten plaster. When the plaster has set and stuck to the inside of the glass, they pulled the tumbler out using the rope that had set in the hardened plaster.

There are also cases in the literature where the foreign body has remained inside the rectal cavity for long periods. For instance, one case published in the Medical Journal of Australia reported that a man had a vibrator removed after six months of it being inside him. The published papers also report the many alleged non-sexual reasons as to how such objects came to be lodged in the rectum. Common ones include accidentally falling on the specified object or item after showers or baths, and deliberate insertion of the object or item to dislodge constipated fecal mass. Some stories are a little more elaborate such as one published in the Southern Medical Journal where the man who said he had slipped on a glass jar while washing his dog in the shower. In the same paper, another man who was found to have a vibrator stuck in his rectum claimed to have been abducted and sexually assaulted by a group of men rather than admit that the incident was self-inflicted.

One of the most bizarre cases was reported in a 2004 issue of the journal Surgery. Here the authors described what they believed was the very first case of something living lodged in the rectal passage. After reporting abdominal pain, and being diagnosed with peritonitis, an X-ray revealed that the 50-year-old man had a 50cm long eel stuck inside his abdomen (claiming he had inserted it to relieve his constipation. The authors even provided all the photographic evidence in their paper. It is also worth mentioning at this point that a paper on anorectal trauma in a 1989 issue of the American Journal of Forensic Medicine and Pathology by Dr. W.G. Eckert and Dr. S. Katchis. They commented on what has now come to be called felching (and which I covered in a previous blog). More specifically they said: “A sexual practice has been mentioned recently where living rodents, including gerbils and mice, have been inserted into the rectum; the animal’s futile efforts to claw its way to safety result in mucosal tears in the rectum”. However, as I noted in my previous blog, no actual cases have ever been reported in the medical literature.

In a previous blog I wrote on klismaphilia (a sexual paraphilia in which individuals derive sexual arousal and pleasure from the receiving of enemas), I reported a case by Dr Peter Stephens and Dr Mark Taff in the American Journal of American Pathology. They wrote about a young man who turned up at the hospital complaining of rectal pain. After an examination by the doctor, it became apparent that there was a stony hard mass lodged in the man’s rectum. Upon further questioning, the patient revealed that four hours earlier, he and his boyfriend had been “fooling around” and that after stirring a batch of concrete mix, the patient had laid on his back with his feet against the wall at a 45 degree angle while his boyfriend poured the mixture through a funnel into his rectum. The concrete had set and had to be removed by the medical team. On removal, a ping-pong ball was also found. The reason a ping-pong ball was also found in the rectum was because klismaphiliacs use the ball as a plug to promote retention and increase stimulation. The use of such a device suggests the person was an experienced klismaphiliac. As Dr Anil Hernandas and colleagues conclude “as the exploration of anal eroticism increases in popularity, more and more cases of complications as a direct result of their abuse are likely to be encountered”.

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

Further reading

Benjamin, H.B., Klamecki, B. & Haft, J.S. (1969). Removal of exotic foreign objects from the abdominal orifices. American Journal of Proctology, 20, 413-417.

Buzzard, A.J. & Waxman, B.P. (1979). A long standing, much travelled rectal foreign body. Medical Journal of Australia, 1, 600.

Byard, R.W., Eitzen, D.A. & James, R. (2000). Unusual fatal mechanisms in nonasphyxial autoerotic death. American Journal of Forensic and Medical Pathology, 21, 65-68.

Eckert, W.G, & Katchis, S. (1989). Anorectal trauma: Medicolegal and forensic aspects. American Journal of Forensic Medicine and Pathology, 10, 3-9.

Goldberg, J.E. & Steele, S.R. (2010). Rectal foreign bodies. Surgical Clinics of North America, 90, 173–184.

Graves, R.W. & Allison, E.J, Bass, R.R., et al. (1983). Anal eroticism: Two unusual rectal foreign bodies and their removal. Southern Medical Journal, 76, 677-678.

Hemandas, A.H., Muller, G.W. & Ahmed, I. (2005). Rectal Impaction With Epoxy Resin: A Case Report. Journal of Gastrointestinal Surgery, 9, 747–749

Lo, S.F., Wong, S.H. & Leung, L.S., et al. (2004). Traumatic rectal perforation by an eel. Surgery, 135, 110-111.

Memon, J.M., Memon, N.A., Solangi, R.A., & Khatri, M.K. (2008). Rectal foreign bodies. Gomal Journal of Medical Sciences, 6(1), 1-3.

Schaupp, W.C. (1981). Commentary. American Journal of Surgery, 142, 85-88.

Stephens, P. & Taff, M. (1987). Rectal impaction following enema with a concrete mix. American Journal of Forensic Medicine and Pathology, 8, 179–182.

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