Three case reports of severe trauma caused by fisting have been published in December 2004 edition of Sexually Transmitted Infections. All three cases involved HIV-positive gay men. Fisting has been associated with the sexual transmission of hepatitis C virus and the rare sexually transmitted infection, lymphogranuloma venereum (LGV).
The three men attended for emergency medical care between three and 36 hours after experiencing internal trauma in separate incidents caused by fisting, and in one case the use of large sex toys. All three men had been attending sex parties and had used recreational drugs, including ketamine, ecstasy, cannabis and poppers. Rectal bleeding was experienced in each of the cases and two of the men reported feeling a “pop” or “tear.” Emergency surgery was conducted on each of the men and all three recovered from their injuries. The Chelsea and Westminster Hospital, London, Europe’s largest HIV treatment centre, provided both HIV and emergency trauma care to the men.
“These patients highlight concerns regarding unsafe sexual behaviour…under the influence of drugs which increase the duration of sexual activity”, write the investigators, who also note that although the men had been engaging in fisting for several years, they were unaware of the symptoms of colorectal perforation. The investigators add that had the men “delayed their presentation any further, the outcome could have been fatal.”
Physicians need to be aware that individuals with injuries caused during sex may delay presentation because of embarrassment, fear of stigmatisation, or ignorance of symptoms, the investigators warn. The authors also stress that doctors need to be aware of the possible symptoms of trauma caused by fisting or the use of sex toys, and need to take sensitive sexual histories.
Although fisting is often viewed as an esoteric activity, data from the 2002 Gay Men’s Sex Survey indicated that over 12% of gay men had engaged in the practice in the preceding twelve months. Although the investigators note that many gay men “practice fisting safely using lubricant and latex gloves”, they also note that few reports about the infections (including hepatitis C virus) which can be transmitted by fisting, and the injuries caused by fisting, reach gay men. Following these cases, information about the potential risks of fisting were made available to individuals attending both the Chelsea and Westminster’s sexual health and HIV clinics.
Cohen CE et al. Sexual trauma associated with fisting and recreational drugs. Sex Transm Infect 80: 469 – 470, 2004.