Penile Hair Strangulation in an Adult Male: An Interesting Case

Abstract

Penile hair strangulation is a rare clinical entity seen in infants and young children caused by entanglement of maternal hair around coronal sulcus. It is mostly accidental, and circumcision is a risk factor. An interesting case of penile hair strangulation in a 64-year-old adult uncircumscribed paraplegic male with erectile dysfunction has been described.

Penile strangulation is caused by circumferential constriction of the coronal sulcus by foreign materials like heavy metal rings, hammerheads, plastic bottlenecks, sprockets, and plumbing cuffs. ¹ Accidental strangulation by maternal hair is common in the pediatric population. We report a case of penile strangulation secondary to a hair tourniquet in a 64-year paraplegic patient.

A 64-year-old uncircumcised male with paraplegia presented to us with progressive pain and swelling in his penis for 7-10 days. On examination, long black hair was found encircling the penis near the coronal sulcus along with ulceration and foul-smelling pus discharge. There was tenderness and edema of the glans penis distal to the entrapment. (Figure 1a, b) The entrapped hair was cut using a blade following which there was relief in symptoms and oral and topical antibiotics were prescribed (Figure 2). In psychiatric consultation, he admitted to suffering from erectile dysfunction and that his friend had suggested he use a rubber band to cure his erectile dysfunction. He was unable to procure a rubber band, so instead used his daughter’s hair which was lying around on the floor and was accessible to him. He had no substance addiction or abuse. Detailed history and relevant investigations including Magnetic Resonance Imaging (MRI) of the brain were done to rule out organic causes. Apart from his urge to cure his erectile dysfunction, he had no other psychiatric problems.

Figure 1.

Circumferential Constriction of Penis Near Coronal Sulcus with Hair.

Figure 2.

Relieving the Constriction by Cutting Hair Coil.

Penile strangulation is an unusual clinical condition characterized by constriction of the penis by various objects. In middle‑aged and elderly men, the leading reasons for applying these foreign bodies are to increase sexual performance or autoerotic intentions, while in adolescent males it is masturbation and sexual curiosity. ² In infants and young children, it is accidental but child abuse and intentional use to control enuresis should also be ruled out. ³

Hair has great tensile strength and contracts as it dries. Most reported cases of penile strangulation by hair have been incidental and seen in infants and young children, with the oldest reported case being in an 11-year-old child. ⁴ Circumcision is considered a risk factor as the hair can coil more easily around the circumcised penis. ³ We found only 1 adult case report of penile strangulation by hair in an uncircumcised 57-year-old male, however, the underlying cause was not mentioned. ⁴ In our case the patient was uncircumcised and the underlying reason was to improve his sexual performance. It is possible that the presence of foreskin may hide the extent of injury and delay seeking treatment in adults. Clinically, there will be edema due to obstruction of venous and lymphatic drainage. Progressive edema can reduce arterial blood supply causing loss of penile sensation, ulceration, necrosis, urethral injury, urethra-cutaneous fistula, gangrene, and finally, autoamputation. All suspected cases should be examined under proper lighting after retracting the foreskin. Neo-epithelialization over the constricting item may mask the constricting material, probing can be attempted in these cases. Penile strangulation is an emergency and requires early intervention depending on the severity of injury. In the initial stages, simple detachment of the hair coil is sufficient. Skin ulcerations and necrosis require careful debridement with primary closure of the defect. In urethral injury and urethra-cutaneous fistula; urethroplasty, repair of urethra-cutaneous fistula, and ventral dartos fascia coverage at the site of defect is needed. Detailed history taking in confidentiality followed by psychological evaluation, counseling, and treatment, if required should be done in all adult patients to find the underlying cause and avoid further episodes.

To conclude, penile strangulation by hair is a rare but potentially serious condition in adults. Thorough history taking and keen clinical examination after retraction of the foreskin is a must for all doctors to identify the constriction and treat it timely to avoid any mechanical and vascular injury.

Authorship Statement

The manuscript has been read and approved by all authors, the requirement for authorship as stated has been met, and each author believes the manuscript represents honest work.

Prakhar Srivastava: Writing – original draft; writing – review and editing (equal). Niharika Dhattarwal: Writing – original draft; writing – review and editing (equal). Prashant Verma: Conceptualization; revision.