I suppose it is simply due to the fact that I belong to a much older generation that I am not able to come to grips with the modern methods of adornment of the human body. Men shave their heads and cultivate stubble on their faces – I often wonder how it is that they can keep it looking every day like they haven’t bothered to shave for five days. Young women seem to be fascinated with tattoos on their shoulders or buttocks or both. And both genders seem unable to get enough metallic devices shoved through their various body parts.
Blokes started wearing ear rings quite a while ago – much to my amazement. Now, men and women quite commonly have a row of rings piercing both ears. Looking into throats now-a-days frequently reveals a steel pin, with a small, coloured, ball attached, stuck through a tongue. Eyebrows, lips, nipples and navels of both genders commonly have rings dangling from them and not even the genitals are spared from attack.
A young, adult male recently presented to E.D. complaining of anal pain. I had a look and diagnosed a small, external haemorrhoid which required only simple analgesic cream. What caught most of my attention, however, was the cluster of steel pins through his penis. Twenty one in number, each had been thrust through a pinch of skin (certainly not through the body of the organ). On each end was a small plastic knob.
I volunteered that it was none of my business but I asked if he would mind explaining it to me. In fact he was quite proud of it and said it was the trendy thing to do. I asked what he did with the bolts during intercourse. He just left them there, he said, and his girl friend loved them. He didn’t consider himself at any risk of infection or trauma. And that was that. My comprehension was not improved.
On another occasion a very angry mother literally dragged her fifteen year old son into the department. She was angry at him, not at us, because he had pierced an ear lobe himself with a needle and inserted a cheap stud. It had become infected and he now had grossly swollen and inflamed ear lobe which dripped yellow pus. Mum wanted the ring removed immediately. The boy didn’t want me to touch it, which was not at all surprising, as it was very painful. Eventually we got him to consent to me having a close look.
My heart sank because I could not see any part of the stud - it had been engulfed by the swollen and inflamed skin. I began to think he would need a general anaesthetic to incise the tissues, drain out the pus and locate and remove the stud. Neither Mum nor the boy was keen on that suggestion. Mum explained that all I had to do was unclip the fastener on the back end of the stud somehow and the shaft would come free. All very well but I couldn’t see any part of the stud let alone the clip.
I explained I could possibly gently probe with a pair of fine artery forceps in the hope of feeling the clip then grasp it and free it. We decided to give it a go. The boy was quite stoic about the procedure until, much to my amazement, I felt the forceps contact metal. He began to shout at me to stop while Mum shouted louder at me to get on with it. I maneuvered the forceps into what I thought was the correct position to squeeze the clip and release it and - it did so. The boy let loose with a tirade of vituperation which brought other doctors, nurses and orderlies rushing into the room thinking I was being bashed or worse. Mum was shouting at him to shut up and he suddenly did so as I lifted out the forceps with the clip attached. The stud popped out the other side without assistance. Pus and blood ran freely from the wound. Sweat poured freely from my brow.
We cleaned him up, dressed the wound and gave an antibiotic by injection with a script for follow up oral antibiotics. I asked if they wanted to keep the stud. The boy said yes but Mum grabbed it and threw it into the bin. That was that. He was big enough to swallow his pride and thank me for my efforts with a hand shake. I didn’t think I deserved it as it was not one of my prouder surgical moments.
Another chap presented one Monday with a grossly swollen, obvious infection in his left eyebrow. The ball screwed onto the top end of a stud could be just seen. The other end was invisible. He told how he had a “few beers” on Saturday night and had tripped and fallen on his garden path. On waking on Sunday he realised he had hit his face on the path and he had the beginnings of a black eye. He did nothing about it until Monday when it was obvious to him his wound was infected. So he presented to us.
Gently palpating the swelling with gloved fingers I could feel the steel ball on the bottom of the stud deep beneath the skin. At least that confirmed it was still there, was still attached to the stud and had not been lost in the fall. But what to do, short of deeply incising the infected skin, to locate and remove the thing?
With fine artery forceps I was able to grasp the stud immediately beneath the protruding upper steel ball. Then I was able to manipulate the lower ball to pass back through the opening it had torn in the deeper tissues and pop it onto the surface. I could then grasp the stud with another fine forcep to immobilise and control it while I unscrewed the upper ball. That done the stud and lower ball easily slid out. I could only sigh when he thanked me but asked me to clean, reassemble and put the stud and balls into a clean container for him to take home for reinsertion later.
Then there was the guy who presented with what he called a “torn penis”. In fact his description of the injury was accurate but I still have my doubts about the veracity of how it came about. He told me he had a ring through the frenulum - the small fold of skin on the under-surface near the end - until about an hour previously. He said he decided to see how far he could stretch the skin by tying a piece of string through the ring and the other end to a table. (Please do not ask me why – I didn’t ask!). As he was stretching things out his mother-in-law, of all people, happened to walk into the room. He turned away in haste – a bit too much haste, as it turns out – because the ring tore through the skin. He did not elaborate on any discussion with his mother-in-law or her reaction.
He didn’t much enjoy the injection of local anaesthetic but was quite stoic about it and I assumed that the piercing had been done without it anyway. But I was as gentle as I could be and inserted two stitches to close the tear.
Later, while driving home, I wondered what would happen if the guy with the penile studs manages to get one or more of them infected. I fear we are in line for an epidemic of such afflictions. I suppose that, if I had a rush of blood to the brain, and decided to offer the insertion of objects into the human body, I would smartly be hauled before the medical board and severely admonished if not struck off! But society and health authorities turn a blind eye to the activities of shady characters who perform these acts of mutilation in dingy premises, and pharmacists, too, for that matter, and often on the bodies of minors. Oh well, I suppose they all take solace from the fact that we silly buggers in E.D.’s and the plastic surgeons will save them from the consequences of their own stupidity.
Body piercing is the trendy thing for the young people to do but it can cause major problems. My dentist tells me the tongue piercing wears away the enamel at the back of the front teeth. Rings, in particular, can catch on objects and tear through the skin - even without being tied to tables. They can cause severe infections and subsequent illness and scarring. Most, however, do not cause any complications – they just look unsightly to most people of my generation – and wonderful to the young people.
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