Skip to main content

Penile Pearls

Penile pearls, genital beading or subcutaneous penile modifications are objects placed beneath penile skin for body modification. Materials include plastic, glass, metal and other substances. They are distinct from penile prostheses used to treat erectile dysfunction.[1][2]

Assessment​

Document the material if known, number, location, timing, insertion method, symptoms and the patient's wishes. Examine for infection, exposure, tissue injury, bleeding and involvement of deeper structures. Ask about urinary symptoms, altered sensation, pain with intercourse and partner discomfort.[2]

Visibility on imaging depends on the material. Do not assume every bead is radiopaque or that an unrevealing radiograph excludes one. Ultrasound can help define depth and proximity to the corpora. Additional imaging or urethral evaluation should answer a specific concern; routine CT is unnecessary for an obvious superficial bead without complications.[1][2]

Removal and referral​

The evidence consists largely of small observational reports. A seven-patient emergency-department series illustrates selected management approaches; it cannot establish complication rates or a universal removal technique.[2]

  • Asymptomatic, intact modification: removal is not automatically urgent. Discuss observation or elective removal according to examination findings and the patient's preference.
  • Infection, abscess or draining tract: assess promptly for source control and appropriate antimicrobial treatment. Systemic illness or suspected necrotizing infection requires emergency management.
  • Exposed bead: assess skin viability, infection and depth; arrange removal with urgency guided by those findings.
  • Deep, ventral or anatomically uncertain placement; significant bleeding; suspected urethral, corporal or neurovascular injury: obtain urologic assessment. Selected superficial dorsal objects may be removable under local anesthesia, but this should not be generalized to all locations or materials.[2]

Counsel about possible scarring, sensory change and reconstruction if removal leaves a significant defect. Use a respectful exposure history to guide infection testing. Document partner symptoms and difficulty with condom use when relevant.[2]

References​

1. Chung AD, Aswani Y, Tsai LL. Imaging review of male genitourinary devices and augmentations. European Journal of Radiology. 2026;199:112829. doi:10.1016/j.ejrad.2026.112829.

2. Kirkham CL, Monks SM, Crawford SB. Complications of subcutaneous penile modifications: a discussion of emergency department presentations and management. International Journal of Emergency Medicine. 2019;12:22. doi:10.1186/s12245-019-0241-z.

See also: Free Silicone Injection, Urethrocutaneous Fistula, Fournier's Gangrene.