title: Artificial penile bodies-from kama sutra to modern times.
abstract: BACKGROUND
  Artificial penile nodules are defined as inert objects inserted beneath the skin of the penis to enhance the pleasure of female/male sexual partners during intercourse.
  
  
  OBJECTIVE
  The aim of this article is to present our experience in dealing with artificial penile bodies. We have also reviewed the pertinent literature focusing on social, motivational, and occupational characteristics of individuals adopting this sexual practice, diagnostic dilemmas and the surgical and health side effects of the implantation of artificial penile nodules.
  
  
  METHODS
  We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized.
  
  
  RESULTS
  The phenomenon of inserting self-made artificial nodules beneath the skin of the penis was first described in the Kama Sutra, the classic Indian treatise on love. It is most commonly observed among men from Southeast Asia. The occurrence is much less common in western cultures, but it has been reported to occur in Romania, Germany, and among Fijians and Russian immigrants in Israel. Furthermore, four cases of self-inserted artificial penile bodies from our clinical practice are presented and discussed.
  
  
  CONCLUSIONS
  The most common motive associated with foreign artificial bodies on the penis is sexual or erotic in nature and that is to enhance the pleasure of female or male sexual partners during sexual intercourse. Most of the reports involve members of low economic groups like gang members, soldiers, drug addicts, sailors, labor workers, and prisoners. Men suffer no serious side effects after insertion, although fixed beads can cause rupture of condoms. For women, the beads can cause abrasions and a few days of postcoital vaginal pain. Penis implants and inserts and other penis augmentation devices are potentially dangerous to both men and women, and of questionable value in bringing pleasure to either, and should be discouraged.
authors.affiliation: University Clinic of Urology- Medical Faculty Skopje, University "Ss Cyril and Methodius", Skopje, Macedonia.
authors.forename: Oliver
authors.initials: O
authors.lastname: Stankov
authors.affiliation: University Clinic of Urology- Medical Faculty Skopje, University "Ss Cyril and Methodius", Skopje, Macedonia. Electronic address: o_ivanovski@yahoo.com.
authors.forename: Ognen
authors.initials: O
authors.lastname: Ivanovski
authors.affiliation: University Clinic of Urology- Medical Faculty Skopje, University "Ss Cyril and Methodius", Skopje, Macedonia.
authors.forename: Zivko
authors.initials: Z
authors.lastname: Popov
mesh_terms: D000328:Adult; D003075:Coitus; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D010413:Penis / Q000601:surgery*; D019919:Prosthesis Implantation / Q000009:adverse effects; D019529:Sexuality; D055815:Young Adult