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Visual diagnosis : Pearling : a case study
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Permanent Link: http://ufdc.ufl.edu/AA00008939/00001
 Material Information
Title: Visual diagnosis : Pearling : a case study
Series Title: International Journal of Emergency Medicine
Physical Description: Archival
Language: English
Creator: Nguyen, David P.
Desai, Bobby K.
Falgiani, Michael
Publisher: BioMed Central
Publication Date: 2011
 Notes
Abstract: 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.
General Note: Publication of this article was funded in part by the University of Florida Open-Access publishing Fund. In addition, requestors receiving funding through the UFOAP project are expected to submit a post-review, final draft of the article to UF's institutional repository, IR@UF, (www.uflib.ufl.edu/ufir) at the time of funding. The Institutional Repository at the University of Florida (IR@UF) is the digital archive for the intellectual output of the University of Florida community, with research, news, outreach and educational materials
 Record Information
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution.
Resource Identifier: doi - 10.1186-1865-1380-4-74
System ID: AA00008939:00001

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CASEREPORT OpenAccessVisualDiagnosis:Pearling:acasestudyDavidPNguyen,BobbyKDesai*andMichaelFalgianiAbstractWepresentthecaseofapatientwhoattemptedtoperformatypeofbodymodificationknownas pearling or genitalbeading whileinprison.Thispatientunfortunatelycausedseveretraumatohispenis,requiringsurgical intervention.Photographsofthetraumaticinjuriesarepresented.Background Pearling, alsoknownas genitalbeading isthepracticeofpermanentlyinsertingsmallbeadsmadeofvariousmaterialsbeneaththeskinofthegenitals[1].As wellasbeinganaestheticpractice,thisisusually intendedtoenhancethepleasureofpartnersduringsexualintercoursebyincreasingphysicalstimulation.Itis mostcommonlydoneonthedorsalsurfaceoftheshaft ofthepeniswheresmall,superficialincisionsaremade andbeadsareplacedundertheskinsurface.Most implantsaremadeofsmallinertmetalbeads(stainless steel,titanium)orplasticbeads(nylon,silicone). Thisformofbodymodificat ionisstillpracticedin variousworldcultures.Historically,theYakuzaofJapan, anorganizedcrimesyndicate,isthemostwellknown for pearling. Eachpearlsupposedlysymbolizeseach yearthatwasspentinprison.Interestingly, pearling hasbecomemorecommonplaceintheUnitedStates, especiallyintheUSprisonsystem.CasepresentationA19-year-oldmaleinmatepresentedtoourEmergency Department(ED)afterattemptingtopurposefullycut thedorsalsurfaceofhispeniswithabrand-newrazor bladeforself-performed pearling. Hemadetwohorizontalincisionsontheshaft,oneproximalandcloseto thebaseofthepenis,andonedistalneartheglans penis.Thiswasperformedapproximately6-7hpriorto arrivalattheED.Thepatientalertedtheprisonstaffto requestmedicalevaluationafterhenotedworsening pain,swellingandecchymosistohispenis,aswellasa significantamountofbloodwhenurinating.Upon arrival,thepatientappearedtobeinnoacutedistress, withoutobviousactivebleeding.Hedenieddysuria. IntheEmergencyDepartment,thepatient sinitial vitalsignswere:temperatureof37C,pulseof84beats perminute,respiratoryrateof16,andbloodpressureof 141/88mmHg.Hisairwaywaspatentwithclear,bilateralbreathsoundsandunlaboredbreathing.Oncardiac examthepatienthadaregularrateandrhythm.His abdomenwassoft,non-tender,andnon-distended.Neurologicalexamrevealednogrossmotororsensory deficits. Afterremovalofbandagingplacedbyprisonmedical staff,hisgenitourinaryexamrevealedanuncircumcised peniswithtwohorizontallacerationsonthedorsal shaft,oneabout1.5cmfromthebaseofthepenisand about1cminwidth,andtheotherabout1cmfrom theglansandabout1cmwide(Figures1and2).There wasnoactivebleedingtothelacerations.Therewasdiffuseedemaandecchymosisonthedorsumofthepenis withbloodclotsoverthewounds.Thewounddepth wasnotexploredatthatpoint.Therewasnoparaphimosisorphimosisnoted.Testesweredescendedand nontenderbilaterallywithnopalpablemasses. Urologywasemergentlyconsultedforsurgicalevaluation.PriortoUrologyarrival,thepatienturinatedintoa portableurinal,whichrevealedgrosshematuria. Perurologicalassessment,hismarkedpenileecchymosisandgrosshematuriaweresuggestiveofahematoma andpossibledeepinjurytothepenisandorurethra. Thepatientwasconsentedandtakenemergentlytothe operatingroomforpenileexplorationandrepair.A tetanusshotwasgivenpriortoleavingtheED. Intheoperatingroom,thepeniswasdegloved.Itwas foundthatthepatient stwolacerationsinvolvedonly thesubcutaneoustissueanddartosfascia.Therewasno injurytoBuck sfasciaortothetunicaalbuginea.A *Correspondence:bdesai@ufl.edu DepartmentofEmergencyMedicine,UniversityofFlorida,POBox100186, Gainesville32610,FL,USANguyen etal InternationalJournalofEmergencyMedicine 2011, 4 :74 http://www.intjem.com/content/4/1/74 2011Nguyenetal;licenseeSpringer.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommons AttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproductionin anymedium,providedtheoriginalworkisproperlycited.

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smallsubcutaneoushematomawasalsoevacuatedfrom theproximallaceration.Irrigationofthewounds revealedseveralbleedingvesselswithineachwound, andtheywerecauterizedwithBovieelectrocautery.The postoperativediagnosislistedintheoperativereport waslowvelocitysharppenileinjury. Thepatientwassubsequentlybroughttothesurgical recoveryroom(PACU)inst ablecondition,andwhen fullyrecovered,hewasdischargedbacktolawenforcementcustody.Hereceivedinstructionstoremovethe postoperativedressingsthenextday,andwasdischarged with5daysofcephalexinandpainmedication.Hewas toreturntotheclinicin2weeksforapostoperative check.DiscussionPenileinjuries,especiallys elf-inflicted,areuncommon complaintsintheED.Thiscasehighlightsabodymodificationpracticeknownas pearling or genitalbeading. Incontemporarysocieties,thisprocedureisusually performedbyprofessionalbodypiercerswhereitisrelativelysafeandwithoutmajorcomplications.However, pearling hasapparentlygainedincreasingpopularityin theprisonsystemwhereinmateshavebeendoingthis ontheirownwithlimitedtoolsandknowledgeofpenile anatomy.Thiscanleadtodisastrousoutcomesthat needemergencyandsurgicalcare,asseeninthiscase. Otherknowncomplicationsduetopearlinginclude penileabscessandpainonerection[2].Long-termcomplicationscanincludescartissueformationcausing chronicpainand/orerectiledysfunction.Thisisan uncommoninjuryintheED,andifthereisanysuspicionofinjurytodeeppenile structures,includingthe urethra,aurologicconsultationisrecommended.Conclusions Pearling, whileintendedtoincreasethesexualpleasureofpartners,cancausesignificantmorbiditytoindividualsthemselvesduringobjectplacement.ConsentWritteninformedconsentwasobtainedfromthepatient forpublicationofthiscasereportandanyaccompanyingimages.Acopyofthewrittenconsentisavailable forreviewfromtheEditor-in-Chiefofthisjournal. Figure1 Lacerationtodorsalsurfaceofpenis Figure2 Close-upviewoflacerations Nguyen etal InternationalJournalofEmergencyMedicine 2011, 4 :74 http://www.intjem.com/content/4/1/74 Page2of3

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Abbreviations PACU:Post-AnesthesiaCareUnit. Authors contributions DNandBDsawthepatientandobtainedconsent;DNwrotetheinitial report;BDandMFeditedandrevisedthereport,andaddedthediscussion. Allauthorsreadandapprovedthefinalmanuscript. Competinginterests Theauthorsdeclarethattheyhavenocompetinginterests. Received:14September2011Accepted:8December2011 Published:8December2011 References1.FischerN,HauserS,BredeO: Implantationofartificialpenilenodules a reviewofliterature. JSexMed 2010, 7(11) :3565-3571. 2.MarzoukE: Implantationofbeadsintothepenileskinandits complications. ScandJUrolNephrol 1990, 24(3) :167-169.doi:10.1186/1865-1380-4-74 Citethisarticleas: Nguyen etal .: VisualDiagnosis:Pearling:acase study. InternationalJournalofEmergencyMedicine 2011 4 :74. Submit your manuscript to a journal and bene t from:7 Convenient online submission 7 Rigorous peer review 7 Immediate publication on acceptance 7 Open access: articles freely available online 7 High visibility within the eld 7 Retaining the copyright to your article Submit your next manuscript at 7 springeropen.com Nguyen etal InternationalJournalofEmergencyMedicine 2011, 4 :74 http://www.intjem.com/content/4/1/74 Page3of3