Genital pearling: How many can fit? A case report

Penile pearling, or subcutaneous penile implantation, involves inserting small objects beneath the penile skin to enhance sexual pleasure or as a cultural symbol. We report a rare case of a 63-year-old man who presented with a painful scrotal lump and fever. Further evaluation revealed a history of self-inserting 90 subcutaneous penile beads ("pearls") using modified toothbrush handles. Surgical removal was performed using penile degloving technique under regional anesthesia, successfully extracting all 90 implants with uneventful recovery and preserved erectile function at one-month follow-up. This case underscores the need for early recognition and proper management of complications related to penile pearling.