Canberra doctors removed a 10-centimetre fork from inside an elderly man's penis after a bizarre sexual mishap.
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The 70-year-old arrived at the Canberra Hospital emergency department with a bleeding sexual organ.
He told doctors he had inserted the 10cm dining fork into his urethra almost 12 hours earlier in an attempt to achieve sexual gratification.
But the utensil became stuck.
The fork was not visible but doctors were able to feel it from the outside and X-rays showed its position.
Doctors considered several retrieval options before deciding to pull the fork free using forceps and "copious lubrication" while the patient was under a general anaesthetic.
The elderly patient was then sent home.
The medical emergency was so rare the team of three doctors published the case in The International Journal of Surgery last month.
The paper, titled "An Unusual Urethral Foreign Body", said it was rare to see objects lodged in the lower urinary tract.
It went on to list strange objects found inside other parts of the body, including needles, pencils, wire, allen keys, toothbrushes, light bulbs, thermometers, plants and vegetables, leeches, snakes, cocaine and glue.
"It is apparent that the human mind is uninhibited let alone creative," the authors wrote.
The medical team – Krishanth Naidu, Maurice Mulcahy and Amanda Chung – said the fork case was published to create discussion among the medical fraternity "given the great management challenge faced by the oddity and infrequency with which a fork is encountered in the penile urethra".
The doctors said the motives for inserting objects into the sensitive region were difficult to comprehend.
"The practice manifests primarily during states of pathological masturbation, substance abuse and intoxication and as a result of psychological compounders.
"Autoerotic stimulation with the aid of self-inserted urethral foreign bodies has been existent since time immemorial and have presented an unusual but known presentation to urologists."
They said embarrassed patients usually attempted to retrieve the item themselves, risking urethral injury and foreign body migration.
The real danger was infection leading to death, because ashamed patients often delay medical treatment, they said.
Doctors generally try to avoid surgery in such situations, instead choosing an option that would minimise urothelial trauma and preserve erectile function.
The authors said self-inserted male urethral foreign bodies are rare emergencies that urological and general surgeons face on occasion.
While the insertions are unusual, the paper said "any imaginable object is known to be implicated".
