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. • A rare case of extreme penile pearling with a total of 90 subcutaneous implants is reported. • Penile degloving technique enabled complete removal of multiple implants in a single procedure. • Surgical removal preserved erectile and urinary function with favorable short-term outcomes. • Early recognition and culturally sensitive management are essential in penile pearling cases.