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From Southern Medical Journal
A Complication of an Unusual Sexual Practice
Jeffrey A. Summers, MD
Published: 09/08/2003
Abstract and Case Report
Abstract
A patient presented with scrotal cellulitis as a complication of infusing 900
ml saline into his scrotum. He had obtained a kit along with explicit instructions
for performing the infusion through the Internet. This practice may be more
widespread than expected. An Internet search revealed many references to this
procedure, but a MEDLINE search showed virtually no information in the medical
literature. Patients who are considering scrotal inflation, as it is called
in the lay literature, should be warned of the potential complications of this
procedure.
Case Report
A 37-year-old man presented to the office with a painful, swollen scrotum. He 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" consisting of a 1-L bag of saline, tubing, and needle-catheter combination. The stated purpose of using such a kit is the infusion of saline into the scrotum to cause significant scrotal enlargement. The patient had been told that the infused fluid would be reabsorbed during a 2- to 3-day period.
Unfortunately, the patient still had enlargement of the scrotum 4 days after the infusion, and it was quite painful. He stated that he had infused 900 ml fluid before the needle popped out of his scrotum. He was initially pleased with the results, but then he developed erythema and pain during the next 2 days. His request at the office visit was to have the fluid aspirated from his scrotum.
An examination revealed that the patient was afebrile. He had a greatly enlarged,
erythematous, tender, warm scrotum. The swelling of the scrotum completely consumed
his penis. He was promptly referred to a urologist, who prescribed cephalexin
500 mg qid for 7 days, and ultrasonography of the scrotum was performed. The
ultrasonographic scan revealed diffuse scrotal swelling but no distinct fluid
collection or mass. At 2-week follow-up, the patient's erythema had nearly resolved,
and his scrotum was reduced to approximately 20% of its size at presentation.
Discussion
A review of the web site where the patient obtained his kit[1] revealed illustrated, step-by-step instructions for the infusion of saline into the scrotum. To investigate how widespread such practices may be, Google searches were performed with the terms scrotal inflation and scrotal infusion, which produced 516 and 1,390 web pages. Most of these pages were associated with web sites dealing with sadomasochism and fetishes,[2] but several revealed that scrotal inflation procedures have been addressed in the alternative press.[3-6]
A review of the medical literature, however, showed that much less attention has been devoted to the potential complications of this procedure. Although the term scrotal inflation seems to be common in the lay literature, the only references to such a term in the MEDLINE database refer to gaseous inflation of the scrotum.[7, 8] MEDLINE searches with the term scrotal infusion and the combination of cellulitis and scrotum produced similarly limited results, and none of the articles displayed discussed a case such as the one described in this article. The patient's activity essentially constituted a clysis procedure, however, and a 25% minor local infection rate has been described in a nursing home population with clysis.[9]
Given the frequency with which infection occurs in clysis, one would expect
that the infection rate in people who self-administer this procedure might be
even higher. Although the condition of the patient described here did not progress
to Fournier's gangrene, this possible additional complication must be considered.
The physician's discussion with patients who may have such proclivities should
include warnings regarding the potential complications of such activities, including
scrotal cellulitis.
Sidebar: Key Points
* Scrotal inflation with saline is a sexual practice not commonly discussed
in the medical literature.
* Scrotal inflation can result in complications such as cellulitis.
* Remarkably, the equipment required for scrotal inflation can be obtained over
the Internet without a prescription.
References
1. Chase Union web site: http://www.chaseunion.com. Accessed May 13, 2003.
2. Xapp's Dungeon web site: http://fetish.gayhost4free.com/xapp/scrotal_inflation.html.
Accessed December 30, 2002. (Note: This Internet address is no longer correct.
The URL of this web site changes frequently.)
3. Vogels J. At the back. See Magazine, vol 427, Feb 7, 2002.
4. Savage D. Savage love. Philadelphia Weekly 31(8), Feb 20, 2002.
5. Savage D. Savage love. Village VoiceFeb 20-26, 2002.
6. Love B. The Encyclopedia of Unusual Sex Practices. Fort Lee, NJ, Barricade
Books, 1992.
7. Sharma TC, Kagan HN. Scrotal emphysema. Am Surg 1980; 46: 652-653.
8. Bush G, Nixon RK. Scrotal inflation: A new cause for subcutaneous, mediastinal
and retroperitoneal emphysema. Henry Ford Hosp Med J 1969; 17: 225-226.
9. Hussain NA, Warshaw G. Utility of clysis for hydration in nursing home residents.
J Am Geriatr Soc 1996; 44: 969-973.
Authors and Disclosures
Jeffrey A. Summers, MD, Division of General Internal Medicine, Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN
Reprint Address
Reprint requests to Jeffrey A. Summers, MD, 146 W. Park Drive, Suite 9-G, Kingsport, TN 37660. Email: summersj@etsu.edu
South Med J. 2003;96(7) © 2003 Lippincott Williams & Wilkins
The author has no commercial or proprietary interest in any drug, device, or
equipment or any financial interest in any item mentioned in this article.
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