This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Athanasios Droulias

CK Ko

DG Moon

E Akkus

E Rosenberg

Georgios Antoniou

Ioannis Kokkonouzis

J Steffens

JA Eandi

JH Jeong

JL Cohen

K Hohaus

N Lawrentschuk

P Santos

T Lee

TA Behar

English

PubMed

Crossref

BioMed CentralCases Journal
ssOpen AcceCase Report
Penis deformity after intra-urethral liquid paraffin administration in 
a young male: a case report
Ioannis Kokkonouzis*1, Georgios Antoniou1 and Athanasios Droulias2
Address: 1Accident and Emergency Department, Kyparissia General Hospital, Kyparissia, Greece and 2Department of Urology, Kyparissia General 
Hospital, Kyparissia, Greece
Email: Ioannis Kokkonouzis* - pneumo72@yahoo.gr; Georgios Antoniou - dr.antoniou@gmail.com; Athanasios Droulias - noskyp@otenet.gr
* Corresponding author    
Abstract
Background: Self-induced injections of liquid substances mainly for penis enlargement is a well-
documented but still rather uncommon practice in the western world.
Case presentation: Herein we present the case of a 30-year-old male who self-inflicted, twice in
a six-month-period, intra-urethral liquid paraffin and tied up his penis with a cord in order to
achieve both enlargement and elongation. He arrived in our emergency department suffering from
suprapubic pain; physical examination revealed a rather unique deformity of the penis. He finally
refused any treatment and absconded.
Conclusion: Side effects after paraffin administration are various and sometimes severe. Most of
the times surgical treatment is needed and radical excision together with follow-up seems the best
modality. Such practices emphasize on the public's misbelieves and that some aspects of sexual
medicine are yet covered with the veil of misconception.
Background
Injections of mineral oils, like paraffin, have been used,
more often in Eastern Europe and Asia, subcutaneously
and according to our report, even intra-urethral, intending
mainly to penile augmentation. Such materials can not be
metabolized and a foreign-body-reaction occurs. As a
result, health risks may need immediate intervention. This
case also emphasizes on the inability of modern medicine
to uncover established public misconceptions.
Case report
A 30-year-old heterosexual male immigrant of Bulgarian
origin presented to the emergency department complain-
ing of suprapubic pain which started two days prior to
admittance. No history of trauma, TB infection or previ-
ous surgery was reported whatsoever. He stated normal
sex life, normal erection and ejaculation during inter-
course. At the time of observation his vital signs were in
normal range and on physical examination he presented
suprapubic tenderness and his penis was noted to be
abnormally large in circumference, painless but stiff to the
feel with a markedly stricture at the middle of the penis
shaft. The skin was depigmented in many areas largely at
the base. No enlargement of the inguinal lymph nodes
was noted (Legend 1). On digital examination a tender
and mildly painful prostate was the main finding.
At that point the patient reluctantly confessed that he has
infused approximately 8–10 milliliters of liquid paraffin
into his urethra by a small syringe some six months before
and repeated the infusion three months ago. His purpose
was to achieve penis enlargement. In order to avoid the
Published: 7 October 2008
Cases Journal 2008, 1:223 doi:10.1186/1757-1626-1-223
Received: 22 June 2008
Accepted: 7 October 2008
This article is available from: http://www.casesjournal.com/content/1/1/223
© 2008 Kokkonouzis et al; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 3
(page number not for citation purposes)
Cases Journal 2008, 1:223 http://www.casesjournal.com/content/1/1/223entrance of the substance inside the rest of the urinary
tract he tied a string around the base of the penis during
the time of the infusion (matching to the decolorized
region of figure 1). The routine laboratory tests were unre-
markable as well as the culture of urine specimen, which
was sterile, while total PSA was slightly increased. During
his short stay at the emergency department a suprapubic
ultrasonographic evaluation was performed revealing
moderate increase in prostatic diameter, borderline obfus-
cation and lateral lobe microcalcifications. Our patient
refused any further urological consultation or psychiatric
evaluation, strongly denied any treatment and absconded.
Discussion
Some cases of subcutaneous injected liquid substances
like paraffin or vaseline into the urogenital region can be
found in the literature mainly on purpose of penis circum-
ference enlargement. This pathological entity is known as
penile paraffinoma. [1-8] In case no pathological finding
is revealed, physical examination together with medical
history, with emphasis on paraffin injections into uro-
genitalia, can presumably establish the diagnosis. It's not
unusual that the formation of the granuloma appears
even years after the injections. Eandi et al. in a case of a 71-
year-old man reported that the development of the par-
affinoma occurred forty years after a series of penile injec-
tions of unknown substances.[8] Moon et al. contacted a
survey on 357 imprisoned men who had injected mineral
oils into the urogenital region with the use of a semi-struc-
tured questionnaire combined with psychological evalua-
tion. At the majority of the respondents (78%) non-
medical personnel has performed this procedure and their
main motive was the fear of inferiority of their penis or the
weak erectile function. Following the injection two thirds
found no relief, nearly everyone (91%) was not satisfied
with his penis afterwards and finally more than two-thirds
wanted to remove the injected material. [9] More recently,
Pehlivanov et al. in a twenty-five-patient cohort study
reported that the motivation of the majority of them was
to enlarge penis's size and secondly to increase their sex
partners' intercourse satisfaction. This study also empha-
sizes on the fact that non-medical personnel (60%) or the
patients themselves (40%) did the injections. As the study
was retrospectively contacted in a dermatology clinic it is
really interesting that all of them had awkward social
behavior (prisoners and beggars).[10]
Herein we report a case of self-induced intra-urethral par-
affin infusion for penis elongation and circumference
enlargement in a young heterosexual male who was work-
ing as a farm worker. The route of administration is
extremely unusual and it seems that the lyophilic nature
of the substance deceived our patient into believing that it
could diffuse the material into the corpora cavernosa thus
inducing their hypertrophy. Our patient stated that he did
not used needle during the procedure so it seems reason-
able enough to conclude that the effusions were made
after he tied up his penis with the cord. At the same time
a second cord was tied around the penis shaft proximally.
Whilst the most likely diagnosis for this patient, at the
time of arrival at the emergency department, was acute
prostatitis, we found it difficult to prove a causal relation
between the current state of disease and the repeated
intra-urethral infusions of liquid paraffin. In such cases a
diagnostic dilemma is present given the observed latency
period, after which an approved relationship can not be
established.
Side effects could be disastrous, occur in a relatively short
period after and concern the vast majority of patients.
According to the Moon et al. study only 15, 6% did not
experience any abnormalities.[9] At their review study
including 26 cases of sclerosing granuloma, Lee et al.
reported that the symptoms' onset time was approxi-
mately 18, 5 months.[11] Pehlivanov et al. reported that
A rather unique deformity at the penis of this young male has been the result of int a-urethral infusion of paraffi  as this fig-ur  demonstrates Note he examiner's fingerFigur  1
A rather unique deformity at the penis of this young 
male has been the result of intra-urethral infusion of 
paraffin as this figure demonstrates. Note the exam-
iner's finger.Page 2 of 3
(page number not for citation purposes)
Cases Journal 2008, 1:223 http://www.casesjournal.com/content/1/1/223the period between the infusion and the onset of compli-
cations was about one year, when 56% of the injected
patients revealed severe side effect (fistulas and wide
ulcers).[10] So urethral stenosis, inflammation, repeated
urinary track infections, erectile dysfunction of variable
severity, severe ulcers and fistulization seem to be the
most common side effects one has to come up with due to
injected liquid substances. [9-11] The potential co-
appearance of penis squamous cell carcinoma, especially
in elderly patients when ulcerating lesions are present,
must always be taken into account and furthermore needs
urgent handling. [9-12] Moreover psychological evalua-
tion is needed to clarify any underling psychiatric disease
although Moon et al. found no evidence of psychiatric
pathology whatsoever at their cohort-study. [9]
All patients must be encouraged to receive treatment and
radical surgical excision has been proposed as the most
appropriate method to avoid future symptoms. This pro-
cedure includes total excision of the foreign body granu-
loma combined with repair surgical techniques with the
use of scrotal flaps or split thickening skin grafts when this
is necesssary.[10,11,13] Lee et al. in a 26-case review study
reported that after complete excision and appropriate
penoplasty everyone but two of the patients had favorable
outcome.[11] The same result has been reported in every
single case in which patients received surgical treatment in
both Pehlivanov et al. and in Jeong et al. studies, the last
one including 17 patients, without any complaints or
erectile disturbance during follow-up.[10,13] As a result
close collaboration of urologists and plastic surgeons and
a well-scheduled follow-up is needed in order to avoid
surgical complications or future recurrences.
On the other hand there are some reports suggesting a
rather more conservative approach in selective patients.
Rosenberg et al. proposed in a three-patient study that
more conservative measures like minimal surgical inter-
ventions and short-term use of antibiotics should be con-
sidered especially when patient 's cooperation is
laking.[14] Akkus et al. in a 42-year-old man, suffering
from an irregular penile mass with multiple ulcers, void-
ing difficulty and erectile dysfunction due to repeated
vaseline injections, performed local treatment with intral-
esional triamcilone and hot-water baths as the patient
refused any surgical intervention.[6] Lawrentschuk et al.
also treated one patient with oral corticosteroids for a six-
week period resulting in the disappearance of the granu-
loma. The authors suggested that surgery should be
reserved for recurrent or refractory cases after the failure of
steroid treatment. Biopsy in order to exclude malignancy
is therefore needed when no surgical treatment would be
performed.[15] Unfortunately our patient strongly
refused any intervention.
Conclusion
In conclusion we presented a case of a young male who
repeatedly self-infused, intra-urethral liquid paraffin to
achieve penis enlargement. Such cases reflect not only the
insufficiency in public health information, especially in
the developing world, but also the inability of modern
medicine to prove its reason and dissolve popular mis-
conceptions.
Authors' contributions
All of the authors were involved in the management of the
case. IK and GA were involved in the process of writing the
manuscript and AD did the final corrections. All authors
have read and approved the final manuscript.
Consent
Written informed consent was obtained from the patient
for publication of this case report. A copy of the written
consent is available for review by the Editor-in-Chief of
this journal.
References
1. Hohaus K, Bley B, Köstler E, Schönlebe J, Wollina U: Mineral oil
granuloma of the penis.  J Eur Acad Dermatol Venereol 2003,
17:585-7.
2. Cohen JL, Keoleian CM, Krull EA: Penile paraffinoma: self-injec-
tion with mineral oil.  Am Acad Dermatol 2001, 45(6
Suppl):S222-4.
3. Behar TA, Anderson EE, Barwick WJ, Mohler JL: Sclerosing
lipogranulomatosis: a case report of scrotal injection of auto-
mobile transmission fluid and literature review of subcutane-
ous injection of oils.  Plast Reconstr Surg 1993, 91:352-61.
4. Steffens J, Kosharskyy B, Hiebl R, Schönberger B, Röttger P, Loening
S: Paraffinoma of the external genitalia after autoinjection of
vaseline.  Eur Urol 2000, 38:778-781.
5. Santos P, Chaveiro A, Nunes G, Fonseca J, Cardoso J: Penile paraffi-
noma.  J Eur Acad Dermatol Venereol 2003, 17:583-4.
6. Akkus E, Iscimen A, Tasli L, Hattat H: Paraffinoma and ulcer of
the external genitalia after self-injection of vaseline.  The Jour-
nal of Sexual Medicine 2006, 3:170-172.
7. Cohen JL, Keoleian CM, Krull EA: Penile paraffinoma: self-injec-
tion with mineral oil.  J Am Acad Dermatol 2002, 47(5
Suppl):S251-3.
8. Eandi JA, Yao AP, Javidan J: Penile paraffinoma: the delayed pres-
entation.  Int Urol Nephrol 2007, 39:553-5.
9. Moon DG, Yoo JW, Bae HJ, Han CS, Kim YK, Kim JJ: Sexual func-
tion and psychological characteristics of penile paraffinoma.
Asian J Androl 2003, 5:191-194.
10. Pehlivanov G, Kavaklieva S, Kazandjieva J, Kapnilof D, Tsankof N: For-
eign-body granuloma of the penis in sexually active individu-
als (penile paraffinoma).  J Eur Acad Dermatol Venereol  in press.
2008 Mar 18.
11. Lee T, Choi HR, Lee YT, Lee YH: Paraffinoma of the penis.  Yonsei
Med J 1994, 35:344-348.
12. Ko CK, Sarantopoulos GP, Bhuta S, Binder SW: Scalp Paraffinoma
underlying squamous cell carcinoma.  Arch Pathol Lab Med 2004,
128(10):1171-1172.
13. Jeong JH, Shin HJ, Woo SH, Seul JH: A new repair technique for
penile paraffinoma: bilateral scrotal flaps.  Ann Plast Surg 1996,
37:386-93.
14. Rosenberg E, Romanowsky I, Asali M, Kaneti J: Three cases of
penile paraffinoma: A conservative approach.  Urology 2007,
70:372.e9-10.
15. Lawrentschuk N, Angus D, Bolton DM: Sclerosing lipogranuloma
of the genitalia treated with corticosteroids.  Int Urol Nephrol
2006, 38:97-9.Page 3 of 3
(page number not for citation purposes)


Penis deformity after intra-urethral liquid paraffin administration in a young male: a case report

Springer - Publisher Connector

DM: Sclerosing lipogranuloma of the genitalia treated with corticosteroids. Int Urol Nephrol

EA: Penile paraffinoma: self-injection with mineral oil.

EA: Penile paraffinoma: self-injection with mineral oil. Am Acad Dermatol

JL: Sclerosing lipogranulomatosis: a case report of scrotal injection of automobile transmission fluid and literature review of subcutaneous injection of oils. Plast Reconstr Surg

Loening S: Paraffinoma of the external genitalia after autoinjection of vaseline. Eur Urol

Paraffinoma and ulcer of the external genitalia after self-injection of vaseline.

Penile paraffinoma: the delayed presentation. Int Urol Nephrol

Penile paraffinoma.

Seul JH: A new repair technique for penile paraffinoma: bilateral scrotal flaps. Ann Plast Surg

Sexual function and psychological characteristics of penile paraffinoma.

SW: Scalp Paraffinoma underlying squamous cell carcinoma. Arch Pathol Lab Med

Three cases of penile paraffinoma: A conservative approach. Urology

Tsankof N: Foreign-body granuloma of the penis in sexually active individuals (penile paraffinoma). J Eur Acad Dermatol Venereol in press.

Wollina U: Mineral oil granuloma of the penis. J Eur Acad Dermatol Venereol

YH: Paraffinoma of the penis.

http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.277.8750

Penis deformity after intra-urethral liquid paraffin administration in a young male: a case report

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