Jamin Brahmbhatt has a folder on his computer of photos of penises trapped inside foreign objects. One is stuck inside a wedding ring, another is imprisoned in a vacuum cleaner, a third is shoved through a cock ring sex toy with a testicle jammed in beside it. Brahmbhatt is a urologist and he has helped free all of these penises. He asked every patient's permission to take a photo and keeps the images as part of a cache of information that may be useful in the future. He knows that someday he will again remove someone's member from another small circular opening.
"It doesn't happen that often, but it happens," says Brahmbhatt, whose clinic is outside Orlando. "Every urologist I know of has a case like this. I've seen five. It happens about once a year."
Penile strangulation is the sexual practice of inserting one's dick into a small, constricting object, like a metal ring or a bottle opening or even a weight plate meant for a barbell, in a case that made headlines last week after a German man needed firefighters to use a grinder and hydraulic cutter to break the weight.
No one knows how common the practice is. While there is a wealth of case studies on the topic, written mostly by emergency physicians, there are no comprehensive studies on it and there is every reason believe that those who partake in the practice keep it a secret. It is not even listed as a fetish on the kink social networking site FetLife, where "penis whipping" and being "bound penis to penis" are sexual practices dozens of users list on their profiles. But urologists, emergency room personnel and some firefighters—called in for their expertise safely removing people, or their parts, from tight spaces—can attest that it is a thing.
"It is rare and we have less documentation than there are incidences," says Judy Ho, a clinical psychologist and recurring cohost of the syndicated talk show The Doctors. She adds that, judging from anecdotal evidence, "ERs have seen more of this in the last few decades."
Strangulation can be a BDSM activity or it can be a sign of harmful compulsive sexual disorder, Ho says. Men who have experienced trauma, both of a sexual or non-sexual nature, sometimes seek out painful sexual experiences, she says. Also, some who no longer feel sufficient stimulation through usual means might gravitate towards extremes. For compulsive masturbators—those whose self-stimulation interferes with daily life and whose binges can last hours—"there might be a need to up the ante," says Ho.
But this practice is very dangerous. Penises, being penises, swell. After placing a flaccid or semi-erect one in a tight opening, a guy might not be able to get it out after it becomes erect due to the thrill of the act. The engorgement caused by sexual stimulation can be replaced by swelling due to constriction or edema, the inability of fluid to leave tissue. New blood with fresh oxygen can't get through to the penis.
"[W]hen you're [enlarging] it naturally you can get fresh blood in there," Brahmbhatt says. In strangulation, you "lose ability to effectively oxygenate that area." This can pinch or scar the urethra, resulting in long-term pain while urinating. Also, the corpus cavernosum, the tissue that causes the penis to become erect, can be permanently damaged, leading to erectile dysfunction. Penises can turn blue or black due to lack of circulation and there could be tissue death, as was the case with a man in Honduras who had his necrotized penis amputated after it was stuck in a bottle for four days.
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Brahmbhatt says patients in these cases often don't immediately reach out for help due to embarrassment. Sometimes, they've spent hours trying to slide or jimmy their penises out of the object before calling 911 or going to the ER. Once medical professionals are on the case, circulation may have been impeded for an extensive period of time. This is why urologists often get calls from ER doctors about penile strangulation in the middle of the night, Brahmbhatt says.
Because of the lack of comprehensive study, there is no answer as to the usual outcome or the severity of harm done. Physicians publish case studies to outline solutions and guide other professionals who might one day have to remove a penis from some similar object. Many show inventive solutions for a problem not often covered in medical school.
Among recent cases, a 64-year-old Chinese man got his penis trapped in a metal ring, shoved "down to the penoscrotal junction." After 12 hours in this situation, he arrived at an ER, where doctors used small incisions to drain fluid from the penis and then threaded a strand of silk between the swollen mass and ring, using it to slide the ring off.
A 45-year-old man in India stuck his penis in a plastic bottle opening as a part of masturbation and went to the emergency room 18 hours later. Surgeons cut through the bottle using metal Mayo scissors, the kind used for stitches, and placed the man on a catheter for two days.
A 14-year-old American put his penis through a mood ring (like the ones that were fads in the 1970s) "for autoerotic purposes." ER doctors repurposed some of the tools of their trade to remove it. They placed a wooden tongue depressor between the ring and the penis to protect the skin and then used a diamond-tipped bone saw to cut the ring.
Brahmbhatt says he was called into the ER for case in which a surgeon ultimately used an orthopedic saw to cut through a metal cock ring. The 40-year-old patient had struggled to remove it himself for more than 12 hours before calling for help. "I think by the time I saw him, he was beyond embarrassment and grateful that he didn't have any long-term damage," Brahmbhatt says.
He says that, as a urologist, one of his more difficult tasks is consoling patients who are considering dicey ways to enhance their sexual experience, with a partner or alone. "Once or twice a month, I see patients who are considering some kind of sketchy injection or use those pills you can get at the gas station," he says. "I say, 'Hey man, what you do alone is your business but I want you to understand the risks.'"
Brahmbhatt advises against any constriction device, including cock rings from sex toy stores. Vacuum devices made by medical supply manufacturers are a safer option, but men should still consult with a medical professional before using one.
"Don't mess around on your own," he says, "because you only have one penis."
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