Blog Archives

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,

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.

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:

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:

Right Diagnosis (2012). Catheterophilia. February 1. Located at:

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.

Period drama: A brief look at haematophilia and sexualized tampon use

I apologize in advance if today’s blog is a little more unpalatable than usual. If you are in any way prudish or squeamish, then stop reading now. The topic of today’s blog is the haematophilia and sexualized use of tampons. It was while researching my previous blogs on paraphilic vampirism and menophilia (i.e., a sexual paraphilia in which individuals derive sexual arousal from menstruating females) that I came across various references to tampons as a source of sexual arousal and pleasure.

Both menophilia and paraphilic vampirism are arguably sub-categories of haematophilia (i.e., a sexual paraphilia in which individuals derive sexual pleasure and arousal from the tasting or drinking blood). As Dr. Eric Hickey notes in his 2010 book Serial Murderers and Their Victims, in most countries, drinking blood is not a crime. He also notes that in reference to haematophilia:

“The activity is usually done in the presence of others. Most persons engaging in this form of paraphilia also have participated in or have co-occurring paraphilia often harmful to others. In addition, a true hematolagniacis a fantasy-driven psychopath and to be considered very dangerous. According to Noll (1992), such desires are founded in severe childhood abuse. The child may engage in auto-vampirism in tasting his own blood and during puberty. These acts are eventually sexualized and reinforced through masturbation. A progressive paraphilic stage during adolescence is the sexual arousal of eating animals and drinking their blood (zoophagia) while masturbating. The compulsive, fantasy driven, sexual nature of this paraphilia creates a very dangerous adult”.

Dr. Hickey’s book also includes a case study of Peter Kürten (1883-1931), a mass murderer nicknamed the ‘Vampire of Dusseldorf’, who terrified the inhabitants of his home town in Germany (a case study also written about by Dr. Louis Schlesinger in his 2004 book Sexual Murder). Citing the work of criminologist Herschel Prins published in a 1985 issue of the British Journal of Psychiatry, Dr. Hickey recalled that:

Kurten was raised in a very physically and sexually abusive home where he witnessed his alcoholic father raping his mother and sisters. He also engaged in sexually abusing his sisters…At age 11 he was taught by the local dog catcher how to torture dogs and sheep while masturbating. He developed multiple paraphilia including vampirism, hematolagnia, necrophilia, erotophonophilia, and zoophagia and was known to drink directly from the severed jugular of his victims. He raped, tortured, and killed at least nine known victims although he was believed to have murdered several others. He used hammers, knives, and scissors to kill both young girls and women and admitted that he was sexually aroused by the blood and violence. Some victims incurred many more stab wounds than others, and when asked about this variation he explained that with some victims his orgasm was achieved more quickly…Before his beheading he asked if he would be able to hear the blood gushing from his neck stump because “that would be the pleasure to end all pleasures”.

This brief overview shows that Kurten had multiple paraphilias (including necrophilia) and was a genuine haematophile. I picked out necrophilia as one of the co-occurring paraphilias because Dr. Anil Aggrawal has written extensively on necrophilia and noted in both his 2009 paper in the Journal of Forensic and Legal Medicine and his 2011 book Necrophilia: Forensic and Medico-legal Aspects that: “some [necrophiles] remove clothes, especially panties or even tampons from corpses to keep as fetish objects…and their paraphilia is known as necrofetishism”. This was the first-ever academic reference I had read that related to the sexualized and fetishistic use of tampons.

Not only has sexualized tampon use been associated with haematophilia, menophilia, and necrophilia, it is also associated with mysophilia (in which individuals derive sexual pleasure and arousal from filth, and which I examined in a previous blog along with salirophilia). If you want some (non-academic) proof, a number of internet websites cater for tampon-loving mysophiles including Charlotte’s Panties site that sells used tampons and sanitary pads for sexual pleasure. Another avenue to check out is the Men in Menstruation website (that perhaps more accurately should be named ‘Men Into Menstruation’). Another unusual way in which tampon use has been sexualized is in their use in urethral stimulation. A number of medical papers have made reference to the fact that tampons have got stuck in the urethra during self-inflicted sexual stimulation (such as a paper by Dr. W. Kochakarn and Dr. Pummanagura in a 2008 issue of the Asian Journal of Surgery).

While researching this blog I came across dozens and dozens of ‘tampon fetish’ sites (type ‘tampon fetish video’ into Google and you’ll see what I mean – be warned, almost all of them are very sexually explicit such as Bloody Trixie’s Red Fetish Blog). I also came across quite a few men who confessed to their tampon fetish online:

  • Extract 1: “I have a fetish for tampons.  Lots of people think it’s disgusting, and lots of girls especially.  But since I was in Junior High I’ve been fascinated by girls’ periods, and began sneaking into toilets at an early age to look.  There are cool spy cam videos of girls changing tampons.  I love them. I found a good unisex bathroom in our building, and can go there and find fresh tampons.  The idea that it was just in a girl’s vagina, and that she was sitting there slipping it out, and a new one in, turns me on, and I’ll often masturbate.  Sometimes there is blood on the bottom of the seat.  I love pictures of girls with the tampon string showing, and having sex during my girlfriend’s period.  I found a site where girls discuss their periods often in detail, day by day, and I like to read it” (“String Lover”)
  • Extract 2: Recently when my girlfriend stayed over she said we couldn’t have sex because it was her period and after she left I saw a used tampon in the trash. I found it gross at first but then it kind of turned me on, without thinking I licked it I KNOW, I kind of liked it and now 2 months later I’m still eating her tampon blood, does this mean I’m a vampire? (“Sir Valentine”)
  • Extract 3: “I am a 37 year-old male that has a tampon fetish. I love to insert tampons into my rectum. When I insert it I get turned on and sometimes blow my load. It feels so good inside my rectum that I do it daily. It helps hold my poop in to my bowel movement is so full backed up that it pushes the tampon out and my poop goes into my diaper that usually is already soaked full of warm, most pee. The feel of the pee and BM is so great. Any women that would like me to do this to them would be awesome. While you are inserting the tampon into my rectum I’ll insert one into your rectum (“Unpottytrainedfireman”)
  • Extract 4: “I have been a cross dresser for years, and just in the last few years I started wearing tampons and Kotexs. I wear the tampons when I am dressed as a girl, and they give me a greater feeling of being a girl. I wear the kotexs the rest of the time when I am wearing panties and panty hose under my male clothes (“Marry”)
  • Extract 5: “I am a cross dresser and I fully dress as ‘Tami’ every day and when I am always dressed I use tampons and a Kotex because I love the feeling of them and they make me feel more feminine. Right from the start of my cross dressing I started just using Kotex to hide my manhood then I thought it might feel good to put a tampon in  my rear and it felt so good so now I wear them every day while I am dressed (“Tami”)

The first three extracts are all variants of what I would term the archetypal ‘tampon fetish’ (where the tampon itself is sexualized) in some way. In Extract 1 it appears to be linked to voyeurism, in Extract 2 it appears to be linked to menophilia, and in Extract 3 there are associations with both coprophilia and urophilia. The final two extracts are where the tampon is sexualized but only as an adjunct or accessory to the primary paraphilic interest of transvestism (something that I have never seen mentioned in the academic or forensic psychiatry literature). However, there are numerous examples of the practice online, and even an online article on the Blurt It website entitled Is It Okay For Men To Wear Panties and Kotex Maxi Pads?’ There are also websites that cater for tampon fetishes that do not appear to have anything to do with blood. For instance, there are some sites dedicated to those individuals (presumably men) who are sexually aroused by the sight of tampon strings hanging from female genitalia (such as at the Peachy Forum – be warned, this is sexually explicit site) as noted in Extract 1 (above).

Although there have been academic and clinical writings on various ‘blood paraphilias’ (most notably paraphilic vampirism), there is nothing (to my knowledge) specifically on tampon fetishes. Whether empirical research is needed is debatable, but even a quick perusal of the online fetish sites suggest that while it be an understandable niche sexual market, there are definitely admirers and adherents out there.

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

Further reading

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

Aggrawal, A. (2009). A new classification of necrophilia. Journal of Forensic and Legal Medicine, 16, 316-320.

Aggrawal A. (2011). Necrophilia: Forensic and Medico-legal Aspects. Boca Raton: CRC Press.

Benezech, M., Bourgeois, M., Boukhabza, D. & Yesavage, J. (1981). Cannibalism and vampirism in paranoid schizophrenia. Journal of Clinical Psychiatry, 42(7), 290.

Hickey, E. (2010). Serial Murderers and Their Victims. Belmont, CA; Wadsworth Cengage Learning.

Jaffe, P., & DiCataldo, F. (1994). Clinical vampirism: Blending myth and reality. Bulletin of the American Academy of Psychiatry and the Law, 22, 533-544.

Kochakarn, W. & Pummanagura, W. (2008). Foreign bodies in the female urinary bladder: 20-year experience in Ramathibodi hospital. Asian Journal of Surgery, 31, 130–133.

Noll, R. (1992). Vampires, Werewolves and Demons: Twentieth Century Reports in the Psychiatric Literature. New York: Brunner/Mazel.

Prins, H. (1985). Vampirism: A clinical condition. British Journal of Psychiatry, 146, 666-668.

Schlesinger, L. (2004). Sexual Murder. New York: CRC Press.

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:

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

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