Introduction: Body modification seems to be an almost universal cultural phenomenon. Different forms of modification are readily accepted depending on the culture one belongs to. Of particular interest to the field of Urology is the implantation of artificial penile pearls, or “pearling”. This piece aims to shed light on this particular phenomenon and its origins for today’s practicing urologist.
Methods: A review of literature including PubMed search and other historical documents was performed to ascertain a better understanding of this genital modification.
Results: On review, references found to penile pearling date back to at least the 1400s. With origins tracing back to East Asia, an early form of this tradition, prominent in the Philippines, was researched and described by William Henry Scott. He details a bar being implanted through the head of the penis of Filipino males, with beads and decorations being added as they aged, intended for enhanced sexual pleasure of their partners. This tradition has evolved over time and is now more commonly seen as subdermal penile implants. A subgroup of Filipino sailors as well as Japanese Yakuza members have adopted this tradition. Sailors use this as both a status symbol, separating themselves from other international sailors at port, and to also enhance sexual pleasure of their partners. The Yakuza are believed to have added a pearl for each year a member spent in prison. This practice has penetrated the modern day prison population as well. A large Australian study demonstrated 5.8% of participating prisoners had a subdermal penile implant. Seventy-three percent of these men had the implant placed while in prison. With limited materials available in the prison setting, resourceful inmates turn to toothbrushes, dominos, melted plastic caps and deodorant roller balls to fashion the pearls. Today’s urologist should be aware of potential complications from this procedure primarily in the form of infection, whether that be local or blood borne.
Conclusions: Pearling has a long tradition, particularly in Southeast Asian cultures. This practice has become more prominent in the modern era especially, it seems, within the prison population. This population is known to be at inherently increased risk for infection, both local and blood-borne, related to procedures performed during incarceration. The natural history of this procedure is poorly understood and further investigation may provide additional insight. Herein we provide an introduction to the contemporary practitioner, providing awareness of this practice, its origins and potential clinical complications.
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