Insertion of foreign bodies (FB) under the penile skin has been practiced for millennia in various parts of the world [1
]. There are myriad reasons for penile “self-enhancement” using FB; the most common reasons include an attempt to enhance sexual performance, partner pleasure, and penile aesthetics [1
]. In the modern era, a bewildering array of objects including marbles, ball bearings, oils, and modified household items have been reportedly inserted into the penis for this purpose [2
]. Based on reporting trends, this practice appears to be most common in Asia, the Pacific, and Eastern Europe [1
There are relatively few cases of self-insertion of subcutaneous penile FB in the United States. Here, we report three cases of Hispanic men incarcerated in separate southwest United States prisons who utilized similar techniques to insert FB under their penile shaft skin.
A 25-year-old uncircumcised Hispanic male who was recently released from a Texas prison presented with penile edema and erythema. Upon questioning, the patient reported that he had inserted a FB into the shaft of his penis 7 days earlier. This was done on the advice of a fellow inmate who informed him that this procedure would enhance female partner pleasure during intercourse. The FB was a domino that had been crafted into a heart-shaped piece of smooth plastic (). The FB had been introduced by making a stab incision in the mid-dorsal foreskin with a ballpoint pen. Upon examination, the FB was easily palpable in the dorsum of the patient’s prepuce. Purulent drainage was noted from the phimotic, edematous, erythematous foreskin. A dorsal slit incision was performed and the foreign body was delivered. Purulent fluid was expressed, the wound was irrigated, and the dorsal slit was loosely closed with absorbable suture. The patient recovered uneventfully and was discharged on post-operative day 1 but was lost to follow-up.
Heart-shaped bead crafted from domino removed from patient 1.
A 39-year-old circumcised Hispanic male who was incarcerated in a New Mexico prison presented with penile cellulitis and extrusion of a penile FB placed 8 months prior. The patient stated that he had been encouraged by his fellow inmates to modify his penis for enhancement of the sexual pleasure of his future female partners. A fellow inmate utilized a sharpened piece of plastic to make paired, dorsal, and ventral incisions in the patient’s mid-penile shaft skin. Two rosary beads and a horseshoe shaped band carved out of a domino with externally facing “ribbing” was inserted into the dorsal incision and a heart-shaped bead carved from a domino was placed in the ventral incision (). Upon presentation to the emergency department 8 months later, the patient had mild cellulitis and extrusion of the distal aspect of the right arm of the band, which he reported occurred 24 hours earlier after a fall. At the bedside, a dorsal incision was made over the palpable FBs and the band, and two dorsal beads were removed (the patient insisted that the ventrally placed, uninfected heart-shaped bead be left in place). The wound was irrigated and packed and the patient was discharged on 5 days of oral antibiotics, but failed to return for his follow-up appointments.
Multiple FBs removed from patient 2. The band and heart were each crafted from a domino. The beads were obtained from a rosary.
A 28-year old uncircumcised Hispanic male incarcerated in a separate Texas prison was referred from a community hospital after becoming combative during bedside explantation of two infected subcutaneous penile FBs. Under general anesthesia, the two FBs (each were fragments of a domino that had been fashioned into a bone and a diamond-shaped bead) were removed through small skin incisions that were loosely closed. He was discharged the following day but failed to return for follow-up.