Image of the Day 36: A Dangerous Local Practice for Penile Enlargement

A 42 year old gentleman presented with one week history of ulcerative penile swelling and feeling un well. Otherwise, no dysuria, pyuria and scrotal pain.

On examination, patient conscious and alert but in pain, vitals are stable, hydration and perfusion status is adequate and no evidence of severe sepsis.

Examination of penis showed disfigured penile shaft with poorly defined margin of ulcerated with an area of fibrosis. On palpation, there was irregular texture of the penile shaft, firm to hard in consistency, warm and mild tenderness. Examination of testes and hernia orifices were normal.

On further questioning, patient denied of multiple sexual partner but he had history of liquid injection to the penis by street sexual therapist under un sterile method.

Discussion

Men are obsessed with their penis. Things that concern them include unsatisfied with their penile shaft length, girth and the consistency of the penis during erection. This lead to overwhelming growth of the penis enhancement business over the market; including online internet business.

From pills, maneuver, devices and surgery; all of them consist of their own risks and might offer some benefit.

Throughout my observation in my practice in two district of Sabah; Tawau and Lahad Datu, there are increasing numbers of patients suffering from dangerous practice for penile enhancement. This practice involve in injection of the liquid substance into the shaft of the penis by street sexual therapist. It is believed that the substance used is silicon.

Typical complaints are pain, swollen and redness of testis, penile ulceration, painful penis during erection and disfigured penile shaft.

Common diagnosis made usually epididymo orchitis, infected penile shaft or ulcer and siliconosis of the penile shaft. Patient will be admitted for pain control and infection control and later refer to plastic surgeon.

Apart from that, the risk of transmitting dangerous disease especially hepatitis, HIV, tetanus are also concerned in view of flaw procedures consisting of non sterile method and location of practice, sharing of needles and instrument and no proper screening of potential transmittable disease among the patients.

**Permission granted by patient for the use of picture as study material.