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CONTEXT: Myiasis is caused by larval infestation that usually occurs in exposed wounds. Dermatobia hominis is the most common fly species responsible for this parasitic infection. Genital piercing is an ornamental practice used in certain social circles. At placement, it transverses the skin surface and, as such, may be related to complications. CASE REPORT: We report a case of a 31-year-old man with a history of wound infection secondary to genital piercing who was exposed to an environment with flies, leading to myiasis. Mechanical removal and systemic antiparasitic drugs are possible treatments for myiasis. However, prevention that includes wound cleaning and dressing is the best way to avoid this disease. CONCLUSIONS: Genital piercing can lead to potential complications and myiasis may occur when skin lesions are not properly treated.

After an acute sexual assault, children and adolescents often present for medical evaluation and treatment. Physicians have an important role in both the medical and legal components of these cases. Careful physical examination and questioning are important in determining the origin of the trauma. In the presented case report, genital trauma after an acute sexual assault was noted and attributed to the alleged offender's penis piercing. The genital trauma caused by the piercing provided physical evidence linking offender to victim and may have implications for the victim's risk of HIV infection and other blood borne pathogens.

Through the investigation of a rich, qualitative dataset of 484 self-reported genital piercing stories, we significantly expand an understanding of the characteristics, motivations, experiences, and outcomes of persons with genital piercings. While many of our findings confirm and elaborate prior research, some of our findings also challenge this research. In particular, we find that contrary to the expectations of prior research, there is: (1) little evidence to support the frequently made claim that genital piercings are pathological and (2) little evidence to support the alternatively framed claim that genital piercings somehow offer resistance to traditional gender and sexual norms. Instead, we argue that, by and large, genital piercings are just another mainstream and fairly conventional type of body decoration and adornment.

The prevalence of genital piercing among women is increasing. As the popularity increases, the number of complications from infection, injury, and retained jewelry is likely to rise. Techniques to remove embedded jewelry are not well described in the literature. The purpose of this report was to describe a case of a patient with a retained clitoral glans piercing, discuss a simple technique for outpatient removal, and review current evidence regarding associated risks of clitoral piercings. A 24-year-old female presented to the emergency department with an embedded clitoral glans piercing. Local anesthetic was injected into the periclitoral skin and a small superficial vertical incision was made to remove the ball of the retained barbell safely. In conclusion, among patients with retained genital piercing, outpatient removal of embedded jewelry is feasible. While the practice of female genital piercing is not regulated, piercing of the glans of the clitoris is associated with increased injury to the nerves and blood supply of the clitoris structures leading to future fibrosis and diminished function compared to piercing of the clitoral hood.

OBJETIVO: Descrever as práticas e cuidados com a área genital de mulheres universitárias. MÉTODOS: Estudo analítico descritivo, que analisou os hábitos e costumes de 364 estudantes de uma universidade pública do Estado de São Paulo quanto ao uso de roupas íntimas, piercings corporais, tatuagens, depilação e práticas sexuais. Um questionário com 42 perguntas avaliou as práticas habituais mais comuns das universitárias. Todas as perguntas foram autorrespondidas e os questionários, sem qualquer identificação, foram colocados em urnas lacradas para garantir o sigilo das informações. As respostas foram tabuladas em planilha Microsoft® Excel 2007 para obtenção de análise univariável. RESULTADOS: A média de idade das universitárias estudadas foi de 21 anos (DP±2,7), sendo 84% brancas. Participaram do estudo voluntárias das áreas de biológicas (50%), exatas (29%) e humanas (21%). Observou-se que 61,8% das entrevistadas usam calcinhas de algodão, porém, ao mesmo tempo, 75,4% usam calças jeans apertadas, e que somente 18,4% deixam de usar calcinha para dormir. Apenas uma participante relatou ter piercing genital e nenhuma tinha tatuagem. A maioria das universitárias faz depilação genital, sendo que aproximadamente um terço delas o faz de forma completa. Após depilar, dois terços usam produtos como anti-inflamatórios e/ou hidratantes na região. Apenas 62% usam camisinha masculina e 17,6% lubrificante na relação sexual. Metade pratica sexo oral receptor; 17,9% sexo anal e 26,6% delas relatam ter dor no ato sexual. Corrimento vaginal foi relatado após a relação sexual em 25,6% dos casos. CONCLUSÃO:Mulheres jovens de universidade pública brasileira têm muitos hábitos inadequados de cuidados relacionados à sua área genital. Não costumam usar piercings ou tatuagens genitais, mas relatam ter dor no ato sexual e corrimento vaginal após o sexo em um grande número de casos. PURPOSE: To describe the practices and care with the genital area of female college students. METHODS: A descriptive analytical study evaluated the habits and traditions of 364 students from the University of Campinas (Unicamp) regarding the use of underwear, body piercings, tattoos, hair removal and sexual practices. A questionnaire with 42 questions assessed the most current practices among female college students. All questions were self answered and the questionnaires, without any identification, were placed in sealed ballot boxes to ensure the confidentiality of information. The responses were tabulated in Microsoft® Excel 2007 to obtain univariate analysis. RESULTS:The mean age of the college students in the study was 21 years (SD±2.7), and 84% were white. The volunteers who participated in this study were from the biological science area (50%), the exact science area (29%) or the humanity area (21%). It was observed that 61.8% of the respondents wear cotton panties, but at the same time 75.4% wear tight jeans, and only 18.4% wore no panties when sleeping. Only one participant reported having had genital piercing and none of them reported tattooing. Most female college students do genital waxing, and approximately 1/3 of them do so completely. After hair removal, 2/3 apply an anti-inflammatory and/or moisturizer to the region. Only 62% use condoms and 17.6% use a lubricant during intercourse. Half of them receive oral sex, 17.9% practice anal sex and 26.6% of them report feeling pain during sexual intercourse. Vaginal discharge after intercourse was reported in 25.6% of the cases. CONCLUSION:Young female college students from Brazilian public universities have many inadequate care habits related to their genital area. They do not use genital piercing and tattoos, but report having pain during sexual intercourse and vaginal discharge after sex in a large number of cases.

OBJECTIVE: To describe the injuries occurring during consensual or not sexual intercourses, or during particular sexual practices and their medical, surgical and forensic care. METHODS: We reviewed the literature using PubMed database to clarify the diagnostic and therapeutic approach of: (1) in men: fracture of the corpora cavernosa, penile and urethral foreign bodies (piercing, rings) as well as amputation of penis; (2) in women: trauma during consensual or not sexual intercourses. RESULTS: In men, the most common pathology is the rupture of the tunica albuginea of the corpora cavernosa on the erect penis. The diversity of sexual practices, however, exposes urologists to meet trauma less ordinary: strangulation of the penis by rings, genital piercing complications or introduction of foreign bodies into the urethra or under the skin. Less common are traumatic amputations of the penis. In women, sexual trauma are often benign in their clinical presentation but generally occur in the context of sexual violence and require psychological support, forensic and prevention of sexually transmitted infections. CONCLUSION: The literature is mainly based on expert opinion and single-center retrospective series. We summarized for each situation epidemiology, diagnosis and treatment. Language: fr

Female genital mutilation (FGM), also known as female genital cutting or circumcision, encompasses a number of practices involving the partial or complete removal or alteration of healthy female external genitalia for cultural, religious or non-therapeutic reasons. Twelve industrialized countries—Australia, Belgium, Canada, Cyprus, Denmark, Italy, New Zealand, Norway, Spain, Sweden, the UK and the USA—have passed specific laws criminalizing the practice, with other nations, including France and Germany, using existing penal codes and child protection legislation to criminalize the procedure. 1

Healthcare professionals should be aware of the seemingly bizarre practice of genital piercing, as they may sometimes be required to manage the inevitable complications. Copyright © 2011 Wiley Interface Ltd

Case reportWhile eating lunch a 70-year-old man began coughing andexperiencing labored breathing. His guest called anambulance. When the ambulance officers arrived theyfound the patient pulseless and started cardiopulmonaryresuscitation, but were unable to revive him. The Prose-cutor ordered a forensic autopsy to discern if this case wasan autoerotic death/sexual asphyxia or a natural death, asthe man was known to have a very unusual piercing andpornographic material, including several photographs ofhis genitals, was found in his house. At autopsy, theexternal examination of the genitals revealed that the twocorpora cavernosa were separated at the base of the penis(Fig. 1) and surrounded by two golden rings that enclosedthe testicles (Fig. 2). Another golden ring was placedaround the external urethral meatus and the right hemi-gland (Fig. 3).The urethra was interrupted (Fig. 4) and itslumen was encircled by scar tissue, while the penile urethrawas patent (Fig. 5). A thin golden necklace was insertedinto the shaft of the penis and wrapped around the base(Figs. 1, 2). Internal examination revealed the presence offood (pasta) in the airways, from the larynx to the mainbronchial bifurcation. Toxicological analysis revealed ablood alcohol concentration of 1.2 g/l. The cause of deathwas choking due to food aspiration.DiscussionPiercing is the act of creating a fistula-like tract, or simplyan opening in the body, in which decorative ornamentsmay be worn [1]. Earrings have been worn from the earliesttimes, but over the past 30 years increasing numbers ofpeople have single or multiple piercings almost anywherethrough the skin [2]. The sociological importance of thisphenomenon is that virtually every culture has some formof body modification, including tattooing and piercing,which represent the most common examples. Piercing isassociated with many medical problems, i.e. local infec-tion, sepsis, superficial cervical lymphadenopathy, contactdermatitis, edema and hematoma formation, exuberantgranulation tissue, and keloid scars [3, 4].Implantation of penile pearls, penile tattooing, andpiercing represent different forms of genital modifications inmen [1, 5]. Genital piercings commonly involve the glans orthe skin of the penis and scrotum. The motivation for genitalpiercing varies greatly from one individual to another, andmay involve provocation, rule violation, self-expression, riteof passage, or the need to increase self-esteem. Finally, theassociation of genital piercing with certain psychopatho-logical or antisocial behavior suggests a connection betweenerotic piercings and sadomasochism and fetishism [3].Genital piercings may pass through the penile urethra,producing urinary flow changes. These are represented byPrince Albert piercings, Dolphin piercing, Ampallang(horizontal through the glans), and Apadravya (verticalthrough the glans) [1, 2]. Piercing, as well as inserting

Introduction Medical practitioners should be aware of genital piercing and its potential complications. General piercings are associate with complications common to all piercings as well as some unique to urethral piercings. Specifically, the association between carcinoma and genital piercing is not well recognized. Aim The present study is a report of two cases describing squamous cell carcinoma associated with genital piercing. Methods Case reports of two men admitted to an academic medical center. Results A 60-year-old man with a history of HIV and hepatitis C as well as a Prince Albert piercing presented for treatment of a urethrocutaneous fistula. A biopsy of indurated granulation tissue surrounding the fistula revealed invasive, moderately-differentiated squamous cell carcinoma. A 56-year-old man with a history of HIV, hepatitis C, and a Prince Albert piercing presented following a single episode of gross hematuria. He also reported splitting of his urinary stream. On physical examination, areas of necrosis were noted on the glans penis; biopsy revealed invasive, poorly-differentiated squamous cell carcinoma. Conclusions The present study is the first to suggest a possible association between squamous cell carcinoma of the penis/urethra and genital piercing. Patients with genital piercings, especially those with concurrent risk factors such as HIV and HCV, should be counselled about this rare complication. Edlin RS, Aaronson DS, Wu AK, Blaschko SD, Yang G, Erickson BA, and McAninch JW. Squamous cell carcinoma at the site of a Prince Albert's piercing.

Aim. The purpose of this paper is to report the findings of a study exploring factors associated with female and male intimate body piercing, with particular emphasis on health issues. Background. Nipple and genital piercings (intimate piercings) have become common types of body art. Scant medical and nursing literature is available, leading to little understanding of these body modifications by health care providers. Method. A convenience sample of intimately pierced individuals (63 women and 83 men) from 29 states in the United States of America was surveyed via an author-developed questionnaire. Questions focused on demographic characteristics, decision factors and health problems related to intimate piercings. Self-reported characteristics were compared between female and male participants, and participants were compared demographically to United States general population. Results. Participants reported wearing nipple piercings (43%), genital piercings (25%) and both types (32%). Respondents were significantly younger, less ethnically diverse, better educated, less likely to be married, more often homosexual or bisexual and they initiated sexual activity at a younger age than the US population. Deliberate, individual decisions for procurement of the intimate piercings were made. Average purchase consideration was at age 25 (nipple) and 27 (genital); average age to obtain the piercing was 27 (nipple) and 28 (genital) years. Purposes for obtaining the piercings included uniqueness, self-expression and sexual expression. Most participants still liked their piercing (73–90%). Health concerns related to intimate piercings were described by both those with nipple piercings (66%) and with genital piercings (52%) and included site sensitivity, skin irritation, infection and change in urinary flow (male genital). Few STDs (3%) were reported and no HIV or hepatitis. Usually non-medical advice was sought for problems – often from the body piercer. Conclusions. Understanding client rationale is not a necessary prerequisite for providing quality patient care; however, awareness of purposes and decision-making in intimate piercing can help nurses to be sensitive to client needs and plan appropriate health education.

A 33-year-old man was referred to our institution with papillary masses at the urethral meatus and difficulty urinating. Genital examination showed two piercings on the frenulum, which were penetrating the external urethra. Endoscopic examination revealed papillary tumours over the entire circumference of the penile urethra and the piercing site. The tumours were resected transurethrally. Microscopic examination revealed condylomata acuminata. Human papillomavirus types 6 and 66 were detected in the lesions. Retrograde urethral viral infection is rare because of the protection provided by the mucosal immune system. Genital piercing may have facilitated spread of the human papillomavirus into the urethra.

Procedures to prevent the eversion of the foreskin have been in use since antiquity for various reasons. Beginning in ancient Rome as a supposed means of preserving the voice, preputial infibulation largely disappeared in Europe until it experienced a revival during the Victorian era as a clinical weapon in the medical ‘war on masturbation’. Although circumcision was the most common method of preventing masturbation in the USA and Britain, infibulation was frequently used as an alternative, being used in mental institutions and orphan asylums, and receiving endorsement from leading medical authorities.

This article considers women's use of the body as a site of protest by taking up women's participation in non-mainstream body modification. The use of scarification, multiple genital piercing and other practices by women in the lesbian SM movement has been considered self-mutilative (Jeffries, 1994). This article takes a different, but not uncritical, approach by examining the `reclaiming' discourse surrounding these practices and considering how this discourse reflects the feminist poststructuralist project of identity subversion.

Background Body piercing is increasing and so are its complications. We describe a case in which the female partner of an individual who had penile piercing was affected. Case A young female presented to the emergency department with the possibility of a lost/missing foreign body in the vagina. Her partner had had a "Prince Albert" type of penile piercing, which was found to be missing after sexual intercourse. Prince Albert penile piercing is a metallic bead, which is anchored to the urethral opening. On clinical examination, the bead was not found in the vagina but was seen on pelvic X-ray. A thorough sexual history resolved the mystery of the missing Prince Albert. Conclusion Our case suggests that the gynecologist should be aware of the practice of genital piercing and stresses the importance of proper sexual history taking.

Genital piercing has become a “social reality” in our present day culture. Its practice is not limited by sexual preference, gender, age or background. There are a variety of complications, acute and chronic, related to the piercing of both male and female genitalia that can affect the individual and his or her sexual partner. It is therefore imperative for healthcare practitioners to be aware of the various genital piercing practices, the types of jewelry used and the potential complications which may arise in order to appropriately counsel and manage those patients withcomplications relating to their genital piercings.

A fulminant case of streptococcal toxic shock syndrome is described. Early surgery was life saving, and the antibiotic regimen should include clindamycin. The value of secondary measures is discussed. High dose intravenous immunoglobulin (IVIG) has shown promising effects in recent publications. Hyperbaric oxygen (HBO) treatment is under evaluation. Piercing of mucosal surfaces might be associated with severe infections.

Introduction Female genital mutilation (FGM) is illegal. If a child has undergone FGM or is thought to be at risk, a referral should be made to social care or the police. FGM is defined by the World Health Organisation as procedures that include the partial or total removal of the external female genital organs for cultural or other non-therapeutic reasons. There are four main types of FGM – type 1 clitoridectomy, type 2 excision, type 3 infibulation and type 4 other harmful procedures including pricking, piercing, cutting, scraping and burning. There are an estimated 20,000 girls at risk of FGM in the UK. Cosmetic genital surgery is not illegal, nor is circumcision or genital piercing in males. Aim to discuss the controversies around cosmetic genital surgery and piercing and their relation to FGM. Method and results a literature search was performed and findings will be discussed. The discussion will focus on FGM and cosmetic surgery as a spectrum of harmful practices. How does a woman reject one set of cultural behaviours, deemed to be inappropriate and inhumane, when the UK society she is integrating into is tolerant of cosmetic genital procedures? The rationale will be put forward to reform legislation to ensure that girls are protected from all non-medical genital surgery (eg labiaplasty), with regulation of the piercing industry. Currently a genital piercing will not necessarily lead to a prosecution – is it in the public interest to prosecute such a case? Discussion will include the development of an education programme with a focus on FGM for all young people. The pros and cons of regular genital examination (as performed in some countries) will be explored. Conclusion Girls must be protected from FGM, piercing and cosmetic surgery under the age of 18 years. We need to achieve a balance of protecting those who are most vulnerable while empowering them to make their own decisions about their bodies.

This article examines the phenomenon of nonmainstream body modification in contemporary United States, with an emphasis on genital piercing, branding, and cutting in several West Coast cities. Based on participant observation and interviews over a 2-year period, it discusses the pleasures and problems of fieldwork with nonmainstream body modifiers, describes the events at a series of San Francisco body modification workshops, and ends with an explanation of what motivated the individuals in the study to involve themselves in a behavior that is not only physically painful but is considered repugnant and even psychopathological by American society.

Summary A 26-year-old heterosexual man presented with urethral discharge and penile oedema, two days after having a Reverse Prince Albert penile ring replaced. Clinically, he also had genital warts at the piercing tract openings. Investigations revealed positive chlamydial and gonococcal infection of the urethra. The gonococcal isolate was found to be highly resistant to antibiotics and the genotype matched an isolate only once previously recorded in the international database. We discuss how the genital piercing might have affected this patient's multiple infections, the possible contribution of genital piercing to the penile oedema, as well as potential anatomical spread of warts associated with a genital piercing.