Tuesday, February 9, 2010

Glass Toys

Glass toys seemingly have gained in popularity recently, but so has the dangers associated with them. Unexpected breakage can lead to an embarrassing trip to the ER, and it is being seen with increasing frequency. Glass toys should be avoided at all costs - no matter how tempting. One incidence in my practice involved a man in his late 20's taking a jar up his anus, which unexpectedly broke. He arrived at the ER twenty minutes later, having lost a significant amount of blood, where he was immediately taken into surgery. A piece of glass had fragmented, and lodged into his prostate, which required a radical prostatectomy, and he had to wear a colostomy bag for two months, until a second surgery was done to reconnect his bowels after everything had healed. Two units of blood were required during the surgery, and two more afterwards.

Friday, April 3, 2009

Enema safety

Enemas make an exciting addition to any playscene. They have been used medicinally for centuries, and lend themselves particularly well to scenes of medical play: nurse/doctor fetish.  In medicine, they are used to cleanse the colon before medical procedures, or to infuse contrast medium prior to various diagnostic procedures.  Generally speaking, they are relatively safe to administer, with a few exceptions.  

The human colon can hold a tremendous amount of fluid - 4 quarts for a normal sized adult, which is typically what is given in a Barium X-ray study.  In excess of this could lead to a colon rupture, requiring emergency surgery, and a long course of antibiotics.  For cleansing purposes, a series of enemas is required - generally I recommend 2 quarts for the first two, 4 quarts for the next two, and one or two two-quart final cleansing enemas.  To speed up cleansing, add a package of castille soap to the second enema.  

I strongly urge anyone practicing enema play to refrain from adding anything other than castille soap, or glycerin to an enema.  The blood supply of the colon enters the hepatic portal vein, so anything absorbed here goes directly to your liver.  I have heard of many stories in my career of persons adding alcoholic beverages to enemas - it will make you drunk very fast, and could easily lead to alcohol poisoning.  Vinegar is another substance that is nasty - Acetic acid is the eventual breakdown product of alcohol, and the liver can be damaged with an overload - excess acetic acid load is what leads to alcoholic cirrhosis.  So it is fair to say that any substance placed directly in the colon is far more dangerous than taken by mouth, as it is absorbed extremely rapidly, leading to acute toxicity, as it has nothing to compete with for absorbption.

Saturday, January 3, 2009

Anal Stretching - Safe if done slowly

For a time, Anal stretching was considered a form of edgeplay due to scare mongering.  However, this is not the case, and is even a medically accepted treatment for Anal fissures.  However, there are limits, and certain rules must be followed.  The first rule is always start slowly, and graduate to bigger toys over time.  The second rule is never use any sudden violent force.  The third rule is use lots of lubrication.  Lastly, be careful when choosing toys - make sure it has a good base flange, and never use any improvised object, especially glass objects - breakage could mean a trip to the operating room.

Done safely, Anal stretching will not cause any permanent damage.  Stretching this part of your anatomy is no different than stretching your hamstrings - they will return to their normal state within a few hours, so no you will not have fecal incontinence.  In fact, done within reasonable limits, anal stretching is actually beneficial, as hemorrhoids are caused by excessively tight anal sphincters.  While there is no set rule on what is a safe upper limit, there are toys out there that go beyond 5 inches in diameter - something I would not recommend.  For the Lord's Anal stretch procedure, a stainless steel dilator that comes in diameters of 3.5, 4, and 4.5 inches is employed while the patient is under anesthesia - so this is a good guidline.

I recommend that a session should begin with a cleansing - the more the better. I will discuss cleansing more in depth in a future post. A waiting period of about 30 minutes after cleansing is also beneficial.  Afterwards, the session should begin gradually - it can be done solo, or can be employed in a BDSM ritual.  To begin the session, the wife and I make sure we have lots of lubrication on hand - we find Sex grease and Slippery Stuff are the best hands down.  I know some people use J-Lube, but it is messy.  In a typical session, a good selection of five or more toys can be employed.

Some of the places to find good toys include Huse.com, and the Big Sex Toy Store.  Toys for the beginner, all the way to advanced can be found on these sites.  Some of my recommendations from beginner to advanced include:

Up to 2.5 inches
Small Exxtreme Goose (can be used for deep insertion)
Rascal Toys Inmate
Mole Butt Plug
Spike Renegade - The Plow
Spike Hot Pursuit - Skiploader

Up to 3.25 Inches
Medium Exxtreme Goose (can be used for deep insertion)
Spike Power Plug - The Bulldozer (My personal favorite)
Colt Thruster
Silver Bullet
Tripple whammy

Up to 3.75 Inches
Large Exxtreme Goose (Not to be inserted all the way) highly recommended
Chase Hunter Butt Plug (Holds well)
Gum Drops Ace of Spades
Gold Dreams 3.5 inch Butt Plug
Man in a Barrel
Big man in a Barrel
Double Banger
Ms. Butt Plug

Beyond 3.75 Inches
BMF Exxtreme Goose (not to be inserted all the way)
Gold Dreams 4 Inch Butt Plug
Gold Dreams 4.25 Inch Butt Plug
Fat Man in a Barrel (Can be difficult to retain)
Trailer Hitch (Recommended)
Red Boy XL The Challenge
Totem Pole

In addition, there are a handful of toys I have tried, or have heard are unsafe.  Some of the toys I do not recommend include:
Falcon Expander (handle can break)
XX-Large Butt Plug from SI Novelties - Flange is too thin, can be sucked in
Spike Cumquest - flange is too brittle, plastic reinforcing rod
Spike Armadillo - flange is too brittle, plastic reinforcing rod
Tilappia Butt Plug - can cause abrasions
Spike Trophy
Spike Dildozer

What to wear

What to wear during a BDSM session is a matter of which role you are playing, and personal preference.  If you are a sub, usually the lesser the better - but in some occasions more is better in order to provoke sensory deprivation.  If you are a dom or domme, usually more is better - catsuits look very sexy.  The problem with catsuits is what they are made of - you essentially get what you pay for.  At the low end of the scale are the cheap chinese catsuits, which are often accompanied by outrageous shipping fees - leave them to float, they're not worth it.  On the opposite end of the spectrum is high quality European catsuits costing upwards of $300.

I personally don't like latex - you can go from being as hot as hell, to freezing, you have to shave to avoid hair pulling, and it leaves a lingering smell on your skin after you have taken a shower.  My favorite are 4 way stretch PVC catsuits with a Lycra backing - Fetishwear.net produces a good product, as does Slickitup.com - my favorite is the classic latex look slicksuit.  You sweat like a pig, but you don't go from one extreme to the next, and it's comfortable for extended play.  It also has a full crotch zipper for an all-access pass.  I also like the products from Squeeze Dog in the netherlands, though their products are not form fitting enough.  For women, there is a much larger variety of choices.

Tuesday, December 30, 2008

Lubrication, Lubrication

Lubrication is perhaps the most important part of any form of play involving bodily orifices.  There is the do-it-yourself type of lubrication often employed by those who are beginning to experiment with various forms of sexual play, or those who are too embarrassed to visit the local drugstore or sex shop.  Generally speaking, this kind of lubrication is not recommended as it can either present the risk of introducing foreign substances into the body, cause irritation, or even injury - in fact I have seen one man try and use lithium grease!  

Some examples of homemade lubrication include:
  • Unsalted Butter
  • Crisco Shortening
  • Vaseline or petroleum jelly
  • Baby oil or mineral oil
Over the years, the wife and I have tried just about every conceivable lubricant on the market - some have stood the test of time, while some have come and gone.  Out of the ones we have tried, I will break them down into two groups: Drugstore/medical brands which are FDA approved, and Sex shop brands.  Both are generally safe, and each has their merits and drawbacks.  Generally, a good lubricant is suitable for all forms of play.

Speaking, most drugstore/medical brands are water-based, and wash off easily with water.  They contain ingredients which are for the most part benign, though some brands contain chlorohexine gluconate as a perservative.  Frequent use can present a problem for some women as glycerin can lead to vaginal yeast infections if used too frequently.  In terms of consistency, most are good for both vaginal and anal play.  Brands which can be found at your local pharmacy include:
  • K-Y
  • Surgilube
  • Taro Gel
  • Lubafax
The other category is adult store brands, some of which are sold in various pharmacies.  These vary greatly in terms of formulation, and consistency - which can be broken down into three subgroups - Water based, oil based, and silicone based.  In my opinion, I would avoid all oil based lubricants like the plague as they can coat the anus or vagina, and disrupt the natural processes.  Most silicone based lubricants are extremely slippery, but they suffer the drawback of being way too thin - for erotic massage they work fine however.  Another concern with short chain silicones is whether or not they have the ability to enter the bloodstream which has been subjected to debate although cimethicone is used in various FDA approved stomach remedies.  The only silicone based lubricant which I have found to be of adequate consistency is Pjur Original Gel Bodyglide.

The water-based category merits an explanation in itself.  This category comes in forms ranging from liquid to gel, and comes in flavors as well.  The water based lubricants are the safest category, and the most commonly used.  The general rule is - the thicker the better.  I have found that some brands do not keep their lubricity well with body heat, or break down easily with friction.  My top recommendations, are in the following order:
  1. Sex Grease
  2. Slippery Stuff Gel (Glycerin Free)
  3. Doc's Ultra Lube
  4. Colt Slick
  5. Adam & Eve Signature Lube
Brands which we have tried, and are simply absolute rubbish include:
  1. Maximus (Breaks down with friction and body heat)
  2. ID Glide
  3. System Jo products
  4. Moist
  5. Elbow Grease
There is also the category of lubricants with added ingredients, such as de-sensitizing  and warming gels.  Most de-sensitizing formulations contain benzocaine, which is good for introductory play, but often blunt the pleasure associated with BDSM play.  On the other hand, there are a number of warming formulations available, and most work very well for vaginal use.  I have yet to find any commercially available products good for anal use since the K-Y warming gel was reformulated without lactic acid two years ago - instead it contains propylene glycol which the body converts to lactic acid.  There are some products which contain menthol, however the concentration is too low to have an effect.  This is where I find that someone could come and fill an unmet need and such a product could be formulated with a non-toxic mild organic acid and/or menthol.  In medical litterature I came across a woman using Ben Gay and Vicks for this purpose - Not recommended!  Methyl Salicyclate and especially Camphor should never be taken internally as they can cause liver damage!

BDSM Safety 101

BDSM is a complex acronym that is often referred to as bondage, domination, and sadomasochism.  It encompasses a wide variety of activities, or "scenes" - dominance, submission, discipline, punishment, bondage, sexual roleplaying, sexual fetishism, sadomasochism, and power exchange.  Unlike sexual abuse, BDSM must always be safe, sane, and consensual.  

Sexual behavior can be placed on a continuum ranging from chastity, vanilla sex, all the way to edgeplay on the opposite end of the spectrum.  Edgeplay is perhaps what concerns me the most as an emergency medicine physician.  It can be separated into two categories: 
1. Edgeplay that poses an immediate risk of permanent harm or death.
2. Edgeplay that poses a delayed risk of permanent harm or death

The topic I am going to discuss first is the form that presents an immediate risk of permanent harm or death. In my career as an emergency medicine physician I have seen and treated examples of all the various forms of edgeplay mentioned below, with life altering consequences for the patient, and one death in the case of Breath play.  In several cases, it resulted in a trip to the operating room, followed by a hospital stay.  Examples of such play are:
  • Breathplay - poses a risk of asphyxiation
  • Castration - risk of hemorrhaging to death
  • Gunplay - the risk of accidental discharge
  • Penectomy - risk of hemorrhaging to death
  • Knifeplay and Cutting
  • Tongue splitting
  • Fire play
The second category of Edgeplay deals with a delayed risk of permanent injury or death.  Usually, in this case, patients present themselves to their primary care physician, or at the emergency room days or even years after engaging in dangerous sexual activity.  It frequently presents itself in the form of an infection, or some form of functional impairment.  Examples of this can include:
  • Extreme piercing
  • Urethral re-routes
  • Amputations
  • Scrotal suspension
These forms of edgeplay should never be part of any sane consensual BDSM scene - they are unsafe in any circumstance.  Only persons with adequate medical training know the locations of major blood vessels, and how to control bleeding.  Most individuals are also not trained on adequate sterilization techniques, making everything from bacterial infections to HIV in the realm of possibility.