A middle-aged man got his penis stuck inside the neck of a plastic bottle for two months in what was believed to be a masturbation game gone wrong.
The 45-year-old unidentified man, from Nepal, used the neck of a bottle to strangle his penis, a technique sometimes used for sexual pleasure.
When he finally went to A&E two months later, doctors had to use cable wire cutters to free his penis from the strangulation device.
Penis strangulation, which medics say is often attempted as part of a sex ‘game’, can cut off blood supply and even cause penis tissue to rot if left too long.
Medics at the Koirala Institute of Health Sciences said his penis had become extremely swollen due to a lack of blood flow and the patient was on the verge of suffering long-lasting damage.
But the man would not reveal why he did it and never came back in for a follow-up, so doctors do not know how well he recovered.
Writing in the International Journal of Surgery Case Reports, they said ‘the shame felt by patients is the root cause for late surgical consultation’, meaning they are ‘prone to develop complications’.
The 45-year-old man in Nepal cut off the top a plastic bottle to make a penis strangulation device, but would not confess why he had done so
Doctors said penis strangulation is a surgical emergency and often found in patients with mental disorders or attempting to increase their sexual arousal.
People have used different methods, such as tape, plastic bottles, rings and keyrings to carry out the act.
Doctors have to release the penis from the constricting object urgently to preserve blood vessels and body tissue.
Medics said: ‘Strangulation of the penis is often found in psychiatric patients who pursued to improve their sexual performance by prolonging the duration of erection or as part of autoerotic games.’
There is no set recommended treatment because every case is different depending on what device the patient has used, how long it has been left in place, how much damage has been done and the equipment available in hospital to remove it, the doctors said.
The man, who was severely depressed and kept the incident a secret from his family, went to A&E two months after he put his penis in the bottle neck, which he had cut off from the rest of the bottle.
He had previously been diagnosed with severe depression and had attempted suicide on multiple occasions.
The medics failed to remove it with standard cutting equipment, so used a cable wire cutter, which is not routinely used by doctors, to remove the bottle neck.
Medics said the first penis strangulation case was reported in 1755 and dozens of similar incidents have been reported ever since.
In an even more extreme case, two schizophrenic patients who attempted the act had to have their penis amputated, the doctors revealed.
Dr Jamin Brahmbhatt, a urologist at Orlando Health Medical Group Urology, told MailOnline penis strangulation cases are very rate and he has seen two in his career.
He said: ‘The problem that occurs is the device is placed on the penis and then it cant come off.
‘Imagine your wedding band going on easy, but then you have swelling of the hands and it becomes harder to get off.
‘That is what happens in an acute setting around the penis.
‘Whatever is around the penis restricts blow which then causes swelling – but if the swelling is too much and then your body (or your hands) can not reduce the swelling you are “stuck”.’
Dr Brahmbhatt said in the two people he treated for penis strangulation, he used orthopedic saws and cutters to remove the metal penile rings.
He said: ‘We literally had to use a saw and cutter milimeters away from the penis. It’s quite intense.
‘Once the device is cut the penis usually goes back to normal within a few weeks – the bruising and swelling can take a few weeks to subside.
‘In the long run we have to worry about scarring of the penis, abnormal penile curvature, and loss of erections.’
Earlier this year, medics at Marrakech University Hospital had to cut a metal ring from a man’s genitals after the homemade sex toy cut off his blood supply.
The unidentified man confessed that he used the 1.6in (4cm) diameter gold ring for hours after attempting to ‘prolong’ his erection while masturbating.
In a separate case, an elderly dementia patient in Chicago strangled his own penis after wrapping rubber bands around it and leaving them on for three days.
The unidentified 81-year-old had to have emergency surgery after the skin on the tip of his member started to rot.
Yellow and purple patches began to appear on both the shaft and base of his penis because of the lack of blood supply.