Potential Dangers Of Clamping: A Medical Case Report
Self-induced penomegaly
Int J STD AIDS 2006 17: 776
A R Markos
Case report
A 56-year-old Caucasian man presented himself to the Department of Genitourinary (GU) Medicine, with a history of penile tip swelling and a rash of a
few days duration. He gave a history of hypertension and taking a diuretic (bendrofluazide), a calcium channel blocker (cardura). He had noother medical history of note. He gave a history of being in a sexual relationship for the previous eight years with the last sexual intercourse some two weeks prior to clinic attendance. He indicated that he had attended another GU medicine clinic, where he was diagnosed as having non-specificurethritis (NSU).
On genital examination, inspection revealed a remarkable swelling of the penile shaft well beyond the parameters of normality. Most of the skin of the glans penis had lost its pigmentation and the parafrenular area showing atrophy and sclerosis. On palpation, the penile shaft was soft and oedematous superficially, but the underlying
penile body felt hypertrophic and fibrotic (with no tenderness). There was no evidence of inguinal, scrotal or inguinal-scrotal swellings or masses.
Initial in-house laboratory investigations, identified leucocytes in the first catch urine sample (by dip stick). A Gram-stained urethral smear, examined under high-power microscopic magnification, identified multiple white blood cells (WBCs): 10 WBCs/ high power field in five different fields.
There was no evidence of intracellular Gram negative diplococci, on the Gram-stained slide.
When the patient attended the clinic, for the follow-up visit, he spontaneously changed his medical history. He admitted to using elastic bands, to strangulate the penile shaft at the base, so as to maintain erection. He volunteered a history of suffering of penile tip flaccidity during erection, for the previous 25 years, leading to dissatisfaction during sexual intercourse. He admitted to using the elastic bands on a regular basis during every attempt of erection, over the previous 25 years. He reported that this procedure helped him to overcome the penile glans flaccidity, leading to a satisfactory erection. He also reported that the penile congestion does not return back to its original status (following the removal of the elastic bands) at the end of the erection stage. We took an informed consent for further assessment. We took measurements for the penile length in the flaccid state (measured 140 mm), and circumference (measured 130 mm) and in the patientinduced stretched state (measured 180 mm). We also gave the patient a chart to measure the penile length and circumference, during spontaneous erection, at home. He gave a chart showing penile length of 205 mm, and circumference of 165 mm at base, 145 mm at middle and 125 mm below the tip of the penis.
When the patient attended the clinic, for the follow-up visit, he spontaneously changed his medical history. He admitted to using elastic bands, to strangulate the penile shaft at the base, so as to maintain erection. He volunteered a history of suffering of penile tip flaccidity during erection, for the previous 25 years, leading to dissatisfaction during sexual intercourse. He admitted to using the elastic bands on a regular basis during every attempt of erection, over the previous 25 years. He reported that this procedure helped him to overcome the penile glans flaccidity, leading to a satisfactory erection. He also reported that the penile congestion does not return back to its original status (following the removal of the elastic bands) at the end of the erection stage. We took an informed consent for further assessment. We took measurements for the penile length
in the flaccid state (measured 140 mm), and circumference (measured 130 mm) and in the patientinduced stretched state (measured 180 mm). We also gave the patient a chart to measure the penile length and circumference, during spontaneous erection, at home. He gave a chart showing penile length of 205 mm, and circumference of 165 mm at base, 145 mm at middle and 125 mm below the tip of the penis.
The gross penile enlargement in this case is the result of recurrent strangulation of the penile outflow vasculature for some 25 years. This patient’s case is unique on three accounts: (A) the long history of penile strangulation (leading to oedema and fibrosis), (B) the extent of penile enlargement (beyond recordable averages of published studies), and (C) the graded difference in penile circumference with more girth towards the area of strangulation, base (165 mm) as compared to middle (145 mm) and below the tip (125 mm). The subsequent lymphatic obstruction leading to fibrosis is synonymous with filariasis. The preservation of erectile function is also similar to that lymphatic obstruction reported in filariasis and hideradenitis suppurativa. The outcome of penile oedema and fibrosis was not part of the patient’s original intentions or plan, which was directed towards overcoming the penile tip flaccidity.
