Emergent and surgical interventions for injuries associated with eroticism: a review.
BACKGROUND
To review the consequences of sexual activities that can cause severe morbidity and the current emergent and surgical measures for treating them.


METHODS
A computerized search of the English and non-English MEDLINE database (January 1973 to October 2005) identified the major sexual activities that caused injuries requiring emergent or surgical intervention, or both. These activities were grouped by type, pathologic findings, and sites of injury. Cause and symptoms are discussed, as are the radiologic, emergent and surgical interventions employed worldwide.


RESULTS
Two major groups of sexual-erotic activities, whether self-inflicted or accidental, emerged as culpable for most of the injuries. One was hetero-homosexual relations that were associated with penile fracture and Peyronie's disease. The other was related to the sequelae of autoeroticism and included penile constriction devices, anorectal, urethra-bladder, and vaginal foreign bodies as well as autoerotic asphyxiation. Injuries in both groups affected men more than women (e.g., 1.7:1 for foreign bodies in the urethra and 99:1 for anorectal). Complications were either immediate or delayed. Predisposing factors for injury are described. Emergent medical management and corrective surgical measures (usually by urologists and gynecologists for genital involvement and proctologists and general surgeons for rectal involvement) were similar worldwide and the need for them was surprisingly limited.


CONCLUSIONS
Most erotic activity-related injuries are medically or surgically treatable, although some sexual practices can be lethal. Dissemination of information on risk of injury is the best preventive measure.
Yacobi
Yacov
Y
Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel. dr_yacobi@bezeqint.net
Tsivian
Alexander
A
Sidi
A Ami
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001237:Asphyxia / Q000209:etiology*; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D007420:Intestine, Large / Q000293:injuries; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000293:injuries; D012725:Sexual Behavior; D014551:Urinary Tract / Q000293:injuries; D014621:Vagina / Q000293:injuries; D014947:Wounds and Injuries / Q000209:etiology*