Pearling
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Pearling or genital beading is the practice of implanting foreign objects into the subcutaneous tissue of the penis, sometimes for aesthetic reasons and often for increasing sexual pleasure for both parties. Historically, genuine pearls were used (members of the Japanese mafia supposedly inserted one pearl under the skin of the penis to symbolize each year spent in jail), but modern implants are often made of silicone, nylon, Teflon, stainless steel and titanium. Modified household items, such as pushpins, dominos, marbles and ball bearings, have also been reported.33
Case: Pearling: Leave it to the Professionals
Implanted by a professional body-piercer using appropriate sterile equipment, beading is generally safe, though common side effects include inflammation, tenderness, redness and infection. When an inexperienced person places the beads improperly, the body can reject the bead: a bruise and blister forms above the bead, and eventually the implant pushes itself out of the skin. Scar tissue formation, which may cause chronic pain or erectile dysfunction, is also possible.34
A 19-year-old male inmate presented to our emergency department (ED) after attempting to purposefully cut the dorsal surface of his penis with an unused razor blade for selfperformed “pearling.” He made two horizontal incisions on the shaft — one proximal and close to the base of the penis, and one distal near the glans penis — approximately 6-7 hours prior to arrival at the ED. The patient alerted the prison staff after he noted worsening pain, swelling and ecchymosis to his penis, as well as a significant amount of blood when urinating.
Pearling has gained increasing popularity in the U.S. prison system, where inmates, using rudimentary tools and with little or no knowledge of penile anatomy, attempt the procedure themselves. They often require surgical intervention. Genital beading is prevalent in cultures around the globe. Whether for aesthetic reasons or sexual ones, pearling is another example of how people continue to push past what was once considered taboo.
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His genitourinary exam revealed an uncircumcised penis with two horizontal lacerations on the dorsal shaft, one about 1.5 cm from the base of the penis and about 1 cm in width, and the other about 1 cm from the glans and about 1 cm wide. There was no active bleeding to the lacerations. Per urological assessment, his marked penile ecchymosis and gross hematuria were suggestive of a hematoma and possible deep injury to the penis and/or urethra. The patient was given a tetanus shot and taken emergently to the operating room for penile exploration and repair. In the operating room, the penis was degloved. It was found that the patient’s two lacerations involved only the subcutaneous tissue and dartos fascia, without injury to Buck’s fascia or to the tunica albuginea. A small subcutaneous hematoma was also evacuated from the proximal laceration. Irrigation of the wounds revealed several bleeding vessels within each wound, and they were cauterized with Bovie electrocautery. The postoperative diagnosis listed in the operative report was low velocity sharp penile injury. When fully recovered, the patient was discharged back to law enforcement custody with instructions to remove the postoperative dressings the next day, and with five days of cephalexin and pain medication.35
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