What are the infection rates and complications reported in clinical studies of recreational urethral sounding?

1. What the surveys say about infection rates and mild complications

Large internet‑based surveys of men who have sex with men (over 2,000 respondents) report that roughly 10% had tried recreational sounding and that, within the subset who disclosed complications, most described few or only minor problems; one study described a relatively low rate of self‑reported STIs at about 4% and only a handful of self‑reported UTIs or urethral irritation cases (five and four patients, respectively) among those seeking attention ^{[1] [2] [5]}.

2. Evidence for increased infection risk in comparative analyses

Although absolute self‑reported rates in some cohorts appear low, comparative analyses indicate elevated risk: respondents who practiced sounding reported more high‑risk sexual behaviours and a higher prevalence of STIs and UTIs/prostatitis compared with non‑practitioners, with some analyses describing increases in odds of infection up to ~70% ^{[2] [6]}. These findings suggest association rather than proven causation and may reflect overlapping behavioural risk factors in surveyed populations ^{[5] [7]}.

3. Severe, rare infectious complications documented in case reports

Contrasting the survey data, a series of case reports and case series detail severe infectious outcomes from retained or traumatic foreign bodies: prolonged recurrent UTIs that progressed to Staphylococcus epidermidis bacteremia with resultant discitis, vertebral osteomyelitis and psoas abscess have been reported following unnoticed retained sex toys in the bladder, requiring surgical removal, long‑term antibiotics and spine surgery ^{[3] [4]}. Bladder perforation, urethral bleeding and other major injuries requiring operative management are also described ^{[2] [6]}.

4. Mechanisms and spectrum of complications clinicians report

Authors emphasize plausible mechanisms: introduction of non‑sterile objects can introduce bacteria across mucosa, urethral trauma can create false passages and strictures that predispose to recurrent infection, and retained objects or delayed presentation (often due to stigma) increase risk of calcification and deep infection; long‑term sounding has been linked to abscesses, stone formation, diverticula, strictures and fistulae in the literature ^{[8] [9] [10]}.

5. Balancing risk: frequency, bias, and gaps in the evidence

The evidence is heterogeneous and skewed by study type: cross‑sectional surveys capture self‑reported prevalence and mild complications but are subject to selection and reporting bias and may undercount severe but rare events, whereas case reports highlight extreme outcomes without providing incidence estimates ^{[1] [9]}. Published work repeatedly notes underreporting driven by stigma and the predominance of studies in specific subpopulations (e.g., MSM, men with genital piercings), limiting generalizability ^{[2] [9]}.

6. Practical inferences and alternative perspectives in the literature

Urologic authors uniformly warn clinicians to be nonjudgmental and to counsel on risk reduction because infections and traumatic complications can and do occur, yet some reports and vendor guidance argue harm‑reduction measures (sterility, appropriate devices, cleaning, avoiding hollow sounds) may reduce but not eliminate risk; isolated case reports also describe uncomplicated recoveries after retrieval, underscoring variable outcomes ^{[10] [11] [8]}. The literature therefore presents a dual message: most who sound report minor problems, but the practice carries a real, if infrequent, potential for severe infectious and structural complications ^{[1] [3] [9]}.