Emergency department studies only count those who arrive at hospital with a problem, so the real risk cannot be calculated.
In practice
The cases described are mostly objects that became retained, and among the most common are glass objects, which are not designed for this use (Ploner et al., 2020).
What kind of studies there are
Syntheses of studies 1
Observational 3
Descriptive or expert opinion 2
We classify each study by its design. A synthesis of many studies or a randomised trial supports firmer conclusions than a survey or an expert opinion. The design does not tell you whether a result is good or bad.
A systematic review of 54 articles on self-inserted rectal foreign bodies found that the most common motivation was sexual stimulation and that the most common objects were sex devices and glass objects (Ploner et al., 2020).
In US emergency data from 2012 to 2021, more than half of the cases involved sex devices and four in ten patients needed hospital admission (Loria et al., 2023).
Hospital case series agree: in a series of 21 patients, the cause was a sexual preference in most, and in another, of 10 patients, all were men and all eventually admitted to self-insertion, but only one gave an accurate history on admission (Bisgin et al., 2023; Cawich et al., 2017).
In Swedish national data, the incidence rose, especially in men, and in the local register there was an excess of sex toys that led to a laparotomy and a stoma (Dahlberg et al., 2019).
A case-control study of men with HIV who have sex with men in Mexico adds a different risk from the retained object: sharing sex toys was an independent risk factor for hepatitis C infection (Mata-Marín et al., 2022).
Where they disagree
There is no fundamental disagreement between these studies; what changes is the type of object and the severity. None compares safe and unsafe objects or says how often the problem occurs among all the people who have anal sex.
Limits of the evidence
Emergency department studies only count those who arrive at hospital with a problem, so the real risk cannot be calculated. The series are small and from a single centre, and embarrassment delays seeking help and can distort what patients report (Bisgin et al., 2023; Cawich et al., 2017).
The hepatitis C study was carried out in a specific group and shows an association, not the exact route of transmission (Mata-Marín et al., 2022).
The studies, one by one
We have gathered 6 verified studies. Each summary is our own; the quotation in inverted commas is taken word for word from the original abstract, in English.
What they found: A systematic review of 54 articles on self-inserted rectal foreign bodies found that the most common motivation was sexual stimulation and that the most common objects were sex devices (35.7%) and glass objects (17.5%). (Ploner et al., 2020)
Population Patients with rectal foreign bodies, mostly young menJournalActa Gastroenterol Belg
Verbatim quotation from the original abstract (in English)
“Sexual devices (35.7%, n=108) and glass objects (17.5%, n=53) are the most commonly self-inserted rectal foreign bodies.” Ploner et al., 2020
What they found: In US emergency departments (2012-2021), of 885 cases of rectal foreign bodies, 55.4% were sex devices and 40.8% required hospitalisation. (Loria et al., 2023)
Population Adults aged 15 or over treated in emergency departments in the United StatesJournalAm J Emerg Med
Verbatim quotation from the original abstract (in English)
“55.4% of foreign bodies were sexual devices, and 40.8% required hospitalization” Loria et al., 2023
What they found: In Swedish national data the incidence of rectal foreign bodies rose, especially in men, and in the local register sex toys were over-represented among those leading to laparotomy and stoma. (Dahlberg et al., 2019)
Population Patients with an anal and rectal foreign body in SwedenJournalInt J Colorectal Dis
Verbatim quotation from the original abstract (in English)
“in our local register there was an overrepresentation of sex toys leading to laparotomy and stoma” Dahlberg et al., 2019
What they found: In 21 patients hospitalised for rectal foreign bodies at one centre, sexual preferences were the cause in 15 (71.4%). (Bisgin et al., 2023)
What they found: In 10 patients at hospitals in Trinidad and Tobago with retained rectal foreign bodies, all were men, all admitted to self-insertion for sexual gratification and only one gave an accurate history on admission. (Cawich et al., 2017)
Population Men with retained rectal foreign bodiesJournalAm J Mens Health
Verbatim quotation from the original abstract (in English)
“all eventually admitted to self-insertion for sexual gratification” Cawich et al., 2017
What they found: A case-control study of 324 men with HIV who have sex with men in Mexico found that sharing sex toys was an independent risk factor for hepatitis C infection. (Mata-Marín et al., 2022)
Population Men with HIV who have sex with men, Mexico CityJournalPLoS One
Verbatim quotation from the original abstract (in English)
The cases described are mostly objects that became retained, and among the most common are glass objects, which are not designed for this use (Ploner et al., 2020).
If an object becomes retained, or there is pain or bleeding, go to the emergency department without delay and without trying to remove it with instruments.
If you share a toy, clean it between one person and the next or change its condom: in one study, sharing toys was associated with hepatitis C (Mata-Marín et al., 2022).
The studies describe cases with complications; they do not allow us to say which particular toy is safe.
If you have pain or discomfort, speak to a healthcare professional.
