Implantation of beads into the penile skin and its complications

Methods, practices, and complications related to the use of artificial penile nodules within the French Guiana penitentiary

Background

Artificial penile nodules (APNs) are small, handmade objects inserted under the penile skin, a practice deeply rooted in the prison environment of French Guiana, raising significant concerns related to sexual health, including complications and an increased risk of sexually transmitted infections (STIs).

Aim

The primary objective of the current study was to investigate APN practices, methods, and complications in prison and to identify risk factors for complications among APN users and their sexual partners.

Methods

This cross-sectional study was conducted among adult male detainees in June 2023 at the French Guiana Penitentiary (FGP). Eligible participants completed an anonymous 47-question survey addressing sociodemographic data, APN practices, and sexual health. Facilitators played a critical role in distributing and collecting the questionnaires, which were available in five languages to accommodate the prison's population ethnogeographic diversity. Data analysis was conducted using logistic regression to identify risk factors associated with complications.

Outcomes

Outcomes included the prevalence of APN use among detainees, the proportion of individuals experiencing complications, the association between APN characteristics (number and placement) and partner-related complications, as well as the rates of condom breakage and self-reported STI history.

Results

Among 779 eligible detainees, 132 participated (17%). The majority were under 35 years old (67%), and 69% reported having APNs, with a median of 5.2 nodules per user (range: 1-22). The main motivation for APN use was enhancing partner satisfaction (60%), while 5% cited intent to harm. Complications were reported by 25%, including pain (52%), bleeding (41%), and infections (35%). Partner-related complications (pain or bleeding) were significantly associated with having five or more APNs and placement in the foreskin of the penis.

Clinical Implications

Given the high prevalence of APNs in the prison setting and their associated health risks, targeted health education and harm reduction strategies are essential to mitigate complications and promote informed decision-making among detainees.

Strengths and Limitations

The main limitation of this study was its reliance on self-reported questionnaires completed in cells, which may have affected confidentiality, response accuracy, and participation due to prison dynamics and literacy barriers. However, the approach provided valuable insight into a stigmatized topic, and collaboration with facilitators and staff helped achieve meaningful participation.

Conclusion

APNs are deeply rooted in prison culture in French Guiana but pose significant health risks. Findings underscore the need for targeted health education to address these risks, particularly focusing on reducing partner-related complications and promoting informed decision-making about APN practices.

Highlights

Despite their widespread use, APNs pose significant health risks, including pain, infections, and complications for sexual partners, with nearly half of users reporting partner-related issues.This study underscores the need for targeted health education interventions to address these risks and promote safer practices within the penitentiary system.Nearly 70% of detainees reported having artificial penile nodules, with a median of 5.2 nodules per user, highlighting the prevalence of this practice in French Guiana's prisons.A significant link was found between having five or more nodules and partner complications, such as pain or bleeding, emphasizing the impact on sexual health.

Penile Pearls and Pearling: Characteristics and Social Identity from the Perspective of Forensic Pathologists

Penile pearls are artificial implants placed beneath the skin of a penis to provide enhanced sexual experience for the partner or present a stigma of a particular social subgroup (e.g., prisoner, member of a gang). This genital modification is usually encountered in men of low socioeconomic status and prisoners who might (self) implant improvised pearls under poor sanitary conditions. We have only recently started to encounter penile pearls on autopsy, incidentally. The aim of this study was to analyze our autopsy cases with penile pearls to assess the characteristics of these subjects regarding their socioeconomic status, history of imprisonment, substance abuse, as well as the characteristics of implants. Nineteen men were included. Most were born in the 1970s and 1980s, with only elementary/vocational school education (n = 10). Only five men graduated from high school. At least 14 were in prison at some point in life and 13 were unemployed. Ten men were unmarried. In 11 men, regular alcohol consumption was reported. 12 used illicit substances, most with a history of heroin injection. Penile pearls were improvised and made of rigid plastic in 10 men, eight were of soft silicone-like material, and one was of metal. A distinct characteristic was a ribbed contour of some implants. Although this genital modification seems to gain more attention outside of described vulnerable groups, it mostly remains limited to them in our region. It is most likely performed in improvised, non-professional, unsanitary conditions, probably in prisons.

A Case Report on "Pearling": Removal of Infected Objects During Circumcision

The insertion of foreign bodies underneath the skin of the penis is commonly referred to as "pearling." Although rare, there are case reports that describe acute complications such as infection and damage to surrounding penile neurovascular structures; however, there is a paucity of data describing long-term complications and surgical management of such cases. A 43-year-old male presented with a penile abscess secondary to "pearling" five years after insertion. His abscess was drained and selected foreign objects were subsequently removed during a simultaneous circumcision procedure. This report describes a case in which surgical removal of penile foreign bodies was performed during a circumcision without the need for additional incisions. The case is unique in that it details a complication five years after initial insertion with microbiological data to guide adequate treatment.

Complications of subcutaneous penile modifications: a discussion of emergency department presentations and management

Background

Subcutaneous penile modifications (SPMs) are more prevalent in Southeast Asian culture and have been growing in popularity in Western culture. SPMs are often made of domino tiles, or other available pieces of plastic, shaved into a desired shape and placed in unsterile conditions. Previous literature indicates a high risk of infection and the need for surgical removal.

Case presentations

Seven patients presented to the emergency department in the Southwest border region with complications from SPMs. All the patients complained of pain, four presented with signs of infection, and four SPMs required removal in the emergency department. Removal consisted of a dorsal penile nerve block and making an incision over the SPM to remove the foreign body. Three of the patients had their SPMs done during a previous incarceration under unsterile conditions.

Conclusions

SPMs appear to be growing in popularity among Western culture, and emergency department health care providers should be aware of trends in body modifications as well as potential complications. The conditions in which SPMs are often placed pose a high risk for infection. In some cases, placement and/or removal of SPMs pose a risk of damage to the corpora, arteries, and nerves of the penis. In the absence of overt bleeding, or suggestion of neurologic injury, dorsally placed superficial foreign bodies of the penis may be amenable to emergency department removal.

Skin necrosis after self-removal of an artificial penile nodule in a Surinamese man

The implantation of objects in the penis for aesthetic reasons or sexual pleasure is becoming more popular among specific socioethnic groups within both, non-Western and Western countries. The implantation and removal of penile implants is currently often performed unanaesthetised, and in unsterile conditions, putting men who undergo the practice at risk of complications. This paper describes a patient with an infection of the penis after self-removal of a penile implant, requiring urgent medical treatment.

Penile implants among prisoners-a cause for concern?

Background

We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison.

Methods

Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, “Have you ever inserted or implanted an object under the skin of your penis?” If they responded Yes: “Have you ever done so while you were in prison?” Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants.

Results

A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05).

Conclusions

Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.

Visual Diagnosis: Pearling: a case study

We present the case of a patient who attempted to perform a type of body modification known as "pearling" or "genital beading" while in prison. This patient unfortunately caused severe trauma to his penis, requiring surgical intervention. Photographs of the traumatic injuries are presented.

Implantation of artificial penile nodules--a review of literature

INTRODUCTION

The implantation of penile nodules under the foreskin is unusual in Western society. This practice is known in Slavic and Asian cultures and occasionally appears in the western world. We review the historical and medical evidence found in world literature to this date.

AIM

We discuss case reports and other literature on penile nodules and evaluate their medical significance.

MAIN OUTCOME MEASURES

Literature search for MEDLINE publications and additional references from non-Medline indexed publications concerning the implantation of foreign bodies under the foreskin.

METHODS

Literature search for MEDLINE-indexed papers followed by a manual bibliographic review of cross-references. We extended the search to non-MEDLINE references using an Internet-based search engine. More information was retrieved by contacting different experts. A statistical analysis was applied to the data collected.

RESULTS

There seems to be a predominance of penile bead implantation in Asian countries. The average age of a patient was 25.47 years. The average number of beads implanted was 2.71. There is a higher risk of becoming a sexually transmitted disease.

CONCLUSIONS

The prevalence of complications seems to be low. The incidence and severity of early or delayed complications are unknown but are probably underreported. Complications associated with this procedure should be known, especially partner complications. These nodules will possibly be encountered more often in western countries.