title: Cross-sectional study examining four types of male penile and urethral "play".
abstract: OBJECTIVE
  To provide further quantitative and qualitative evidence about men who insert foreign liquids and objects into their penis and/or urethra.
  
  
  METHODS
  As part of a larger, cross-sectional study examining men (n = 445) with genital piercings (GP), 2 questions inquired whether the respondents had penile tattoos and/or inserted other materials, such as fluids and foreign objects, into their penis and urethra.
  
  
  RESULTS
  Four different practices have been described in the literature: embedding (a) foreign objects and/or (b) liquids subcutaneously into penile tissue, as well as inserting (c) liquids and/or (d) foreign objects into the urethra. In our study, 354 (78%) men with GP responded to the 2 questions; 85 (24%) replied affirmatively and 68 (80%) provided comments. Respondents coined their practices penile and/or urethral "play." Two respondents embedded metal balls into their penis, 1 at age 13 injected water for penis enlargement; 11 inserted liquids into the urethra, and 63 reported insertion of 32 different objects, frequently urethral sounds or "sounding" (n = 33/52%) were mentioned. Major motivation themes focused on sexual stimulation and experimentation. Penile tattoos (n = 14) were also reported, mainly for esthetics. Few complications or STDs were reported.
  
  
  CONCLUSIONS
  Basic demographic assumptions of those who participate in these actions were challenged, and this study provides evidence of a wider distribution of men using penile or urethral play, and "sounding." Clinician awareness of these practices are important to obtain accurate health histories, manage genitourinary tract complications, as well as provide applicable patient education.
authors.affiliation: Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA. Katherine.rinard@ttuhsc.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Rinard
authors.forename: Thomas
authors.initials: T
authors.lastname: Nelius
authors.forename: LaMicha
authors.initials: L
authors.lastname: Hogan
authors.forename: Cathy
authors.initials: C
authors.lastname: Young
authors.forename: Alden E
authors.initials: AE
authors.lastname: Roberts
authors.forename: Myrna L
authors.initials: ML
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D046288:Body Piercing; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D004954:Esthetics; D005547:Foreign Bodies / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D010413:Penis / Q000293:injuries; D010988:Play and Playthings / Q000293:injuries; D012309:Risk-Taking; D012649:Self Concept; D012742:Sex Offenses / Q000706:statistics & numerical data; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013653:Tattooing; D014521:Urethra / Q000293:injuries; D014570:Urologic Diseases / Q000209:etiology / Q000628:therapy