Theses:

Kipel B. S., Gain Yu. M. Retrograde migration of a foreign body through the colon.

Subbotin V.M., Davidov M.I., Fainstein A.V. et al. Foreign bodies of the rectum.

Thus, anal masturbation had a substitutive character for them.

In 3 people, a fibrocolonoscope or rectoscope was used to remove foreign bodies.

All patients recovered without any postoperative complications.

In the postoperative period, all patients were examined by a psychiatrist: no mental illnesses were detected.

Maslyak V.M., Lozinsky Yu.S., Cordoba M.T., Dyak L.I. Injuries to other parts of the colon.

Healthcare of Belarus 1989; 8: 64-65.

Likarska right 1993; 2-3: 126-128.

Clinical surgery 1989; 1:60.

**Foreign bodies in the rectum and colon after anal masturbation**

M.I. Davidov, Perm Medical Academy, RF

The author observed 15 men aged 22-71 with foreign bodies lodged in the rectum or colon as a result of anal masturbation. These included cucumbers (3), a rubber phallus (2), a deodorant spray can (2), wooden, plastic, and metal rods, a hammer handle, a carrot, a pine cone, and other items. In 14 patients, transanal removal of the foreign bodies was performed, and in 1 case, a laparotomy with suturing of a rectal tear caused by the foreign body was carried out. There were no complications or fatalities. It was found that 11 individuals had engaged in anal masturbation multiple times, while 4 did so for the first time. It was revealed that the majority (11) of the men had homosexual inclinations, in the absence of a regular homosexual partner, which forced them to resort to anal masturbation.

One of the causes of foreign bodies in the rectum and colon is anal masturbation [2, 4]. J. S. Cohen, J. M. Sackier [5], who observed 48 patients with colorectal foreign bodies, note that in 77% of cases, the latter were inserted into the rectum for the purpose of sexual stimulation. After anal masturbation, a metal screwdriver, a water thermometer, wooden and plastic rods, fruits and vegetables, and other objects were found in the rectum and colon [1,3, 4,6].

At the clinic of the Faculty of Surgery with a course in Urology at Perm Medical Academy from 1980 to 2003, we observed 15 patients with foreign bodies that ended up in the rectum or colon as a result of anal masturbation. This accounted for 41.7% of the 36 patients with foreign bodies in this localization, introduced via the ascending route (through the anal canal). All patients were male. There was 1 patient aged 22, 5 aged 30-39, 3 aged 40-49, 4 aged 50-59, and 2 aged 60-71. After careless anal masturbation, the following items were found in the rectum: cucumber (in 3 cases), rubber artificial penis (in 2 cases), deodorant spray can (in 2 cases), plastic shampoo bottle, wooden stick with a condom on it, wooden hammer handle, plastic stick, carrot, pine cone, metal rod, stearin candle (1 foreign body each). The wooden items were skillfully processed and polished by the masturbators, giving them the shape of an artificial penis. One rubber dildo was expertly made by the patient himself, while the other was purchased at a sex shop and was vibrating, powered by batteries embedded in the casing.

There were 12 large foreign bodies (longer than 15 cm), 3 medium-sized ones (9 to 14 cm in length and 3-4.5 cm in thickness). The largest items were both artificial penises and a plastic rod, which were up to 25 cm long. The wooden and metal rods were each 20 cm long. The most voluminous items with a larger cross-section were one of the cucumbers (20x5x5 cm), a plastic bottle (15x4x4 cm), and two lightweight metal aerosol cans with deodorant (18x4x4 cm and 15x4x4 cm). The danger of the latter was that they contained a flammable gas - butane.

The objects ended up in the rectum, turning into foreign bodies, during the act of "instrumental" anal masturbation. This was the result of losing control over the masturbation tool at the moment of orgasmic sensations, as well as excessively deep insertion of the object or fingers slipping off it.

Only 4 patients sought medical help within the first 12 hours, 4 within 24 hours, and 7 from 24 hours to 4 days. Almost all hoped for the spontaneous passage of the object during defecation, and most made desperate attempts to manually extract the object using various items, including one patient who used a spoon and fork (?!).

Upon hospitalization, 2 patients concealed the fact of using the object. For diagnosis, rectal digital examination, rectal examination with a rectal mirror, plain radiography, ultrasound, rectosigmoidoscopy, and fiber colonoscopy were used. During the examination, the diagnosis of a foreign body in the rectum was established in 4 patients, and in the rectum and sigmoid colon (with elongated objects) in 9. In 2 patients, by the time of hospitalization, retrograde migration of the object into the transverse and descending colon had occurred.

In 14 patients, transanal removal of foreign bodies was performed under general anesthesia, after manual dilation of the anal sphincter, as well as using a forceps, bullet forceps, Alice clamps, Luer clamps, and other instruments. In 3 cases, a fibrocystoscope or rectosigmoidoscope was used for the removal of foreign bodies. One patient, hospitalized with a rupture of the anterior wall of the upper ampullary section of the rectum by a foreign body and the development of diffuse peritonitis, underwent laparotomy, suturing of the rectal wall, temporary sigmoidostomy, sanitation, and drainage of the abdominal cavity. All patients recovered without postoperative complications.

In the postoperative period, all patients were examined by a psychiatrist: no mental illnesses were detected. However, the patients exhibited perverse sexual feelings and psychosexual deviations. These men, aged between 22 and 71, resorted to anal masturbation with various objects for sexual satisfaction, including 11 who did so multiple or regularly, and 4 who did so once. One patient also engaged in transurethral masturbation with various objects, and after another session of masturbation with a branch of blooming lilac, he suffered damage to the urethral walls, leading to the subsequent formation of a urethral stricture.

Most men derived the greatest satisfaction from transrectal pressure on the prostate area (a kind of "instrumental" self-massage of the prostate). Among them, 4 men, who had previously received medical prostate massages for chronic prostatitis, stated that they intentionally used the object to massage the prostate. Eight patients had a history of homosexual relationships (but none had a regular homosexual partner at the time of the incident), and 3 other men reported unfulfilled homosexual desires. Thus, anal masturbation served a compensatory purpose for them. When collecting family histories, it was found that 3 men were married, 4 were divorced, and 2 were widowed. In total, 9 patients were married, of whom 6 had children. A characteristic feature was an unsuccessful family life: a high number of divorces and a lack of sexual satisfaction in marriage during natural intercourse. Only 6 men were single, including middle-aged and elderly individuals, and only 2 of them had heterosexual experiences during their lifetime.

Thus, anal masturbation is most often performed by individuals with homosexual tendencies, the majority of whom do not have a regular homosexual partner. The risk of "instrumental" anal masturbation lies in the threat of forming a foreign body in the rectum or colon, with the associated health and even life dangers.

List of references

1. Kipiel B. C., Gain Yu.M. Retrograde migration of a foreign body in the large intestine. Healthcare of Belarus 1989; 8: 64-65.

2. Maslyak V.M., Lozynskyi Yu.S., Kordoba M.T., Diak L.I. Injuries and foreign bodies of the colon. Medical Practice 1993; 2-3: 126-128.

3. Papazov F.K., Vasilenko L.I., Khosh E.M., Skvortsov K.K. An unusual route of foreign body penetration into the abdominal cavity. Clinical Surgery 1989; 1:60.

4. Subbotin V.M., Davidov M.I., Fainshtein A.V. et al. Foreign bodies of the rectum. Vestn. Khirurgii 2000; 159(1): 91-95.

5. Cohen J.S., Sackier J.M. Gestión de cuerpos extraños colorrectales. J. R. Coll. Surg. Edinb. 1996; 41 (5): 312-315.

6. Vashist M.G., Arora A.L. Sacando una zanahoria del recto. Indian J. Gastroenterol. 1997; 16(3): 120.

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