A 24-year-old Vietnamese man had to have a steel nut cut from his penis using a drill after he stuck it while pleasuring himself.
The unidentified patient went to hospital in Ho Chi Minh City where he told doctors the tether had been stuck there for 10 hours.
He admitted that he pushed the 2cm (0.7 inch) thick hex nut around his shaft to improve his masturbation experience.
The uncircumcised patient complained that his penis had become numb and he was unable to urinate.
His penis was so swollen that doctors could not remove the makeshift pleasure ring by hand and had to use a dental drill to cut it out.
Doctors said the steel nut (left), which measured 2.7 cm (1 inch) wide inside and 4.1 cm wide (1.6 inches) outside, ` ‘tightly imprisoned the shaft of the penis’, caused difficulty in urinating and decreased sensation in his genitals. They finally removed the cock ring after a 45-minute procedure using a hand-held electric dental drill (right) – which are typically used to make holes for fillings and remove plaque, but are also used to remove the rings that get stuck on the fingers.
Doctors, who detailed the incident in the Journal of Medical Case Reports, said the man was admitted to the emergency department of Cho Ray Hospital.
The metal nut had become stuck 5cm (1.9 inches) into his penis and was “tightly trapping the shaft of the penis”.
Doctors noted that this caused the patient to have difficulty urinating and decreased sensation in his genitals.
The man’s foreskin, which was pulled back during masturbation, had become so swollen that it could not return to its normal position and was “choking” the tip of his penis.
The patient was hooked up to an intravenous drip and given painkillers, antibiotics and sedatives.
WHAT IS PENILE STRANGULATION?
Penile strangulation is a rare but often dangerous medical emergency that occurs when an object or body part blocks the blood supply to the penis.
In the worst cases, the lack of blood circulation can lead to gangrene and tissue death – penile necrosis.
Doctors have developed a scoring system to indicate the severity of the strangulation:
1st year: Edema of the distal part of the penis.
2nd year: Skin injury and corpus spongiosum constriction, but no evidence of urethral injury. Distal penile edema with decreased penile sensation.
3rd year: Injury to skin and urethra but no urethral fistula. Loss of sensations distal to the penis.
Level 4: complete division of the corpus spongiosum resulting in a urethral fistula and constriction of the corpora cavernosa, with loss of sensation distal to the penis.
Level 5: gangrene, necrosis or complete amputation of the distal part of the penis.
Due to the thickness of the device and the swelling of the man’s penis, doctors were unable to remove it manually using lubricant.
And they said it was “impossible” to cut the nut using bolt cutters because there was no space between the choke point and the skin of the man’s penis .
After consulting with colleagues at the hospital’s dental clinic, the doctors decided to use a hand-held electric dental drill – which is typically used to make holes for fillings and remove plaque, but is also used to remove the rings that get stuck on the fingers.
They finally removed the cock ring after a 45-minute procedure.
Cutting the metal creates heat as a by-product, so the man’s penis had to be doused with water to cool it down during the procedure.
Doctors also placed a thin piece of plastic between the device and the penis to prevent the shaft from being injured.
After a night in hospital, the man was prescribed antibiotics and painkillers.
A follow-up appointment a month later showed his penis was back to normal and he could urinate and become erect, his doctors said.
Penile strangulation was first recorded in the medical literature in 1755 and has been rarely documented since, with less than 100 official reports.
Cock rings reduce blood flow to the veins, causing the penis and testicles to swell.
Doctors said young men often use the devices as part of masturbation to increase sexual gratification, as well as “sexual curiosity”.
According to their report, older men are more likely to use chokehold items to improve their performance in response to erectile dysfunction.
Doctors have noted that the sexual act is also sometimes performed by people with mental disorders.
Objects including heavy metal rings and cones, pipes, plastic bottle necks and plumbing cuffs were all reportedly used in cases of penis strangulation.
They have warned that “urgent” medical attention is needed when penis rings get stuck, as this can damage blood vessels, which carry blood between organs and the heart.
In cases where the penis is strangled for more than 30 minutes, there is also a risk of sepsis, gangrene – when body tissue turns black and dies – and urethrocutaneous fistula, which is an unwanted opening in the groin where the urine can escape.
Amputation of the penis is necessary in the most serious cases.
Each case of penile strangulation is handled individually, depending on the patient’s case. They noted that most patients delayed seeking treatment due to embarrassment.
Doctors said thin, non-metallic penis rings are ‘often easy to remove’, but metal objects are ‘difficult to remove safely’ as standard surgical equipment ‘may not be able to cut them’ .
Doctors treating patients with penile strangulation must be “creative and resourceful” because not all treatments will work for all patients, with saws and pliers being used before, doctors said.
The team noted that using a dental drill is a ‘rare’ method of removing penis chokehold devices, but it was a ‘great option’ as it cuts ‘very easily in a short time without heavy physical exertion.