Deliberate self-insertion of a perineal needle for sexual pleasure: a new form of autoerotic behavior?

A 55-year-old male patient presented acutely to the urology service having inserted a 7 cm sewing needle into his perineum. He had no prior history of psychiatric illness. He stated that he had performed this practice on a regular basis over severalyears forself-gratification,withoutanypartner involvement. Maximum pleasure was obtained by insertion ofa needle into his perineal body but he had previously always managed to extract the needle by leaving a portion of it exposed. On this occasion, he had inserted it completely 12 hours prior to presenting and was subsequently unable to remove it. He denied any voiding difficulties or bowel symptoms. Physical examination revealed a soft non-tender abdomen and a tattoo covering the penile shaft. Rectal examination was unremarkable. Perineal examination revealed a tender erythematous area over the perineal raphe consistent with recent foreign body insertion. No urethral tenderness was detected. Plain abdominal X-ray demonstrated a thin metallic density opacity in-line with and overlying the inferior fifth of his pubic symphysis (Fig. 1). Computerized tomography demonstrated that all the urogenital structures were intact with a needle lodged anterior to the anus and posterior to the penile root (Fig. 2). Following discussion at a dedicated uroradiological conference, a multimodality approach involving ultrasound localization and extraction under general anaesthesia was offered to the patient. However, as he was asymptomatic, he discharged himself and declined any further intervention. He was informed of all the potential risks in writing but refused treatment and requested no additional hospital appointments. Self-embeddingbehaviorinvolvingsoft tissueforeignbodies is a discrete form of self-injury, typically occurring in patients with mental health concerns. There are reports in the literature of self-insertion of foreign bodies in the forearm for the purposes of attempting self-harm (Wraight, Belcher, & Critchley,2008). Young,Shiels,Murakami,Coley,and Hogan (2010) have identified cases of metal foreign body insertion and highlighted the role of the radiologist in image-guided foreign body retrieval. Multiple reports exist of thoracoabdominal induced trauma secondary to sewing needle injury via stabbingoraccidental ingestion(Sobnach, Castillo, Blanco Vinent, Kahn, & Bhyat, 2011). There are further reports of the incidental discovery of a sewing needle in the liver following investigations for anaemia; these were managed conservatively (Feng, Wang, & Sun, 2009).