Earthworms and other worm-like organisms have been documented in the male urethra across published medical case reports spanning decades, appearing through self-insertion, accidental environmental exposure, or diagnostic confusion with parasitic infections. The phenomenon sits at the intersection of urology, psychiatry, and occasionally tropical medicine, and the published literature reveals a broader pattern of unusual biological and non-biological objects recovered from the male urinary tract. While the cases are individually rare, they recur often enough in the surgical literature to have established clinical protocols for diagnosis, extraction, and follow-up.
What the Case Literature Actually Describes
When clinicians catalog the range of objects recovered from the male urethra and bladder, the lists are strikingly diverse. One widely cited surgical review documented foreign bodies including, among many others, “parts of animals (leeches, squirrel tail, snakes, bones)” alongside household items, wires, vegetables, and various tubes.1PubMed Central. An unusual urethral foreign body That category of animal-derived foreign bodies includes earthworms and earthworm-like organisms, which appear in the case literature both as deliberately introduced objects and as incidental findings during workups for urinary symptoms.
One instructive case involved a 63-year-old man whose bladder yielded what initially appeared to be a parasitic worm. Laboratory analysis using infrared spectroscopy eventually identified the object as an artificial fishing worm, a soft plastic lure shaped and textured to resemble a real earthworm. The case illustrated how realistic these objects can look on imaging and during extraction, prompting clinicians to consider both biological and synthetic foreign bodies in their differential.2Journal of Clinical Microbiology. An unusual foreign body in the urinary bladder mimicking a parasitic worm Cases like this one highlight a recurring challenge: when something worm-shaped turns up in the urinary tract, distinguishing a real organism from an artificial object or a tissue abnormality requires careful pathological and sometimes chemical analysis.
Why People Insert Foreign Bodies Into the Urethra
The most common motivation, by a wide margin, is sexual. A retrospective analysis found that roughly six out of ten individuals who self-inserted urethral foreign bodies did so for autoerotic reasons.1PubMed Central. An unusual urethral foreign body A broader review of the case literature ranks the motivations in roughly this order: erotic stimulation or sexual experimentation, curiosity, behavior tied to intoxication, and a range of psychiatric conditions.3PubMed Central. Urethral foreign bodies: a hidden consequence of autoerotic behavior—a case report – Section: Discussion Self-stimulation and attempts at erectile enhancement appear repeatedly in the demographics data. A 15-year review at one large urban hospital found 27 patients across 35 insertion episodes, nearly all male, with a median age of 26, and the reasons given included self-stimulation, erectile enhancement, and attention-seeking.4PubMed. Urethral Foreign Bodies: Clinical Presentation and Management
For earthworms specifically, the motivations mirror the broader pattern. The soft, elongated shape of an earthworm makes it physically compatible with urethral insertion in a way that harder or more angular objects are not, and case reports describe patients who selected worm-like organisms or artificial worms specifically because of their flexibility. In some psychiatric presentations, the insertion is compulsive rather than pleasure-driven, with patients unable to articulate a clear reason for the behavior.
When the Worm Enters on Its Own
Not every case involves deliberate insertion. In tropical and subtropical regions, aquatic and terrestrial organisms sometimes enter the urethra during bathing, swimming, or prolonged contact with wet soil. The best-documented example involves leeches rather than earthworms, but the mechanism is closely related. A hospital-based study in Bangladesh documented children who presented with leeches that had entered through the urethra, vagina, and rectum during bathing in ponds or open water. Two boys had leeches that migrated all the way into the urinary bladder and required surgical removal through the abdomen.5PubMed. Leech infestation in children through body orifices: experience in a hospital in Bangladesh In another reported case, a boy presented with heavy bleeding and urinary retention after a leech became lodged in the urethra, and early removal was described as potentially lifesaving.6Semantic Scholar. AN URETHRAL LEECH INFESTATION: AN UNUSUAL CAUSE OF URINARY RETENTION AND HAEMATURIA
Earthworms are less likely than leeches to enter the urethra during environmental exposure because they lack the suction mechanisms and blood-seeking behavior that drive leeches into body orifices. But in settings where people bathe in soil-rich water or where children play naked in wet earth, accidental contact is at least mechanically possible, and case reports from rural tropical regions occasionally describe worm-like organisms recovered from the urethra where the patient denied any insertion. These cases are difficult to verify because patients are often embarrassed and may not disclose the full story, and clinicians note that a significant fraction of “accidental” presentations are likely self-inflicted.
Traditional Medicine and Earthworm Use
In some cultural contexts, earthworms are used as ingredients in traditional medical preparations. An ethnobiological survey conducted in the Plateau Department of Benin documented 38 species of invertebrates used in folk medicine, with the African earthworm Eudrilus eugeniae having one of the highest use values among all species surveyed.7PubMed Central. Traditional knowledge of invertebrates used for medicine and magical–religious purposes by traditional healers and indigenous populations in the Plateau Department, Republic of Benin While this particular study documented earthworm use for ailments unrelated to the urinary tract, the broader tradition of using living organisms in therapeutic rituals opens a plausible pathway for earthworms to come into contact with the genitourinary system. Urologists working in regions with strong ethnomedical traditions occasionally encounter cases where foreign bodies were introduced as part of a treatment protocol prescribed by a traditional healer.
How These Cases Present in the Emergency Department
Patients who arrive with a urethral foreign body, whether an earthworm or anything else, tend to show up with a fairly predictable set of symptoms. The most common are localized penile pain, blood in the urine, painful urination, and sometimes complete urinary obstruction.8PubMed Central. Evaluation and management of urethral foreign bodies and description of a novel ultrasound-guided catheter-based extraction technique When the object has migrated into the bladder, symptoms may shift toward lower abdominal discomfort and recurrent urinary infections that do not respond to antibiotics. A significant complication of these presentations is delayed care: embarrassment keeps many patients from seeking help for days or even weeks, during which time the risks of infection and tissue damage multiply.
Diagnosis usually begins with imaging. Standard pelvic X-rays can reveal objects that are dense enough to show up on film, but biological foreign bodies like earthworms are not radiopaque and will not appear on a plain X-ray. For soft-tissue and non-metallic objects, ultrasound and CT scanning are the go-to tools, and direct endoscopic inspection of the urethra and bladder provides definitive visual confirmation.9PubMed Central. Endoscopic removal of self-inflicted urethral foreign body: A case report – Section: Discussion In the fishing-worm case described earlier, the object’s soft plastic composition meant it was not visible on standard imaging and was only discovered during cystoscopy.2Journal of Clinical Microbiology. An unusual foreign body in the urinary bladder mimicking a parasitic worm
Complications When Treatment Is Delayed
The risks of a foreign body left in the urethra or bladder escalate sharply over time, and biological objects like earthworms carry additional infection risk because they introduce bacteria and organic matter directly into a sterile tract. The complications reported in the surgical literature fall into several categories.
Immediate mechanical damage is the most common. A review of self-inflicted urethral foreign bodies found that mucosal tears and the creation of false passages through the urethral wall were the most frequent injuries. Patients who had attempted multiple insertions were more likely to develop urethral strictures, which are bands of scar tissue that narrow the urethral channel and can permanently impair urination.10PubMed. Self-inflicted male urethral foreign body insertion: endoscopic management and complications
Infection is the second major concern. A foreign body provides a surface for bacterial colonization, and the warm, moist environment of the urinary tract accelerates bacterial growth. In one reported case, a self-inserted urethral object led to Fournier’s gangrene, a rapidly spreading and potentially fatal infection of the genital and perineal soft tissues.11PubMed Central. Self-insertion of an odd urethral foreign body that led to Fournier’s gangrene Fournier’s gangrene requires emergency surgical debridement and carries a meaningful mortality rate even with treatment. This represents the extreme end of the infection spectrum, but less severe urinary tract infections and abscesses are far more common consequences of retained foreign bodies.
When objects remain in the bladder for extended periods, mineral deposits begin to accumulate around them, forming bladder stones. Any foreign body that reaches the bladder can act as scaffolding for stone formation, with urinary minerals crystallizing around the object layer by layer.12PubMed Central. A case report of a self-inserted foreign body in the urethra/bladder causing urinary calculus formation, and a review of the literature – Section: Discussion In some patients, these encrusted stones grow remarkably large. Giant urethral calculi, though rare, have been documented in patients where the original foreign body had been in place for months or years.13BJU International. Giant urethral calculus associated with a foreign body – Section: Discussion By the time these stones are discovered, extraction often requires open surgery rather than a simple endoscopic procedure.
The Psychiatric Dimension
Repeated self-insertion of foreign bodies into the urethra has its own clinical term: polyembolokoilomania. While a single episode may reflect curiosity or experimentation, recurrent presentations strongly suggest an underlying psychiatric condition. The behavior has been associated with depression, psychotic disorders, obsessive-compulsive disorder, intellectual disability, and substance use disorders. One case report from Sri Lanka emphasized that the risk of recurrence after surgical removal is high, making psychiatric follow-up a necessary part of treatment rather than an afterthought.14Psychiatry Research Case Reports. A case report on Urethral Polyembolokoilomania from Sri Lanka-psychiatric perspective – Section: Discussion
The clinical consensus reflected in the case literature is that urological intervention alone is insufficient for these patients. A multidisciplinary approach that combines acute surgical management with psychiatric evaluation and long-term mental health care provides the best chance of preventing recurrence and additional injury.15PubMed Central. Urethral self-insertion of foreign body; a peculiar doorway to a psychiatric diagnosis: a case report – Section: CONCLUSION In practice, this often does not happen. Patients are treated surgically and discharged without psychiatric referral, and many return weeks or months later with another object. The repeat-visit rate in case series involving multiple episodes from the same patients underscores this gap. In the Cook County Hospital review, 27 patients accounted for 35 episodes, meaning some individuals presented more than once.4PubMed. Urethral Foreign Bodies: Clinical Presentation and Management
Legal and Forensic Considerations for Clinicians
These cases carry legal weight that many clinicians may not immediately appreciate. The self-introduction of a foreign body into the urinary tract can be an indicator of self-destructive behavior, and the published forensic literature draws a direct line between this behavior and suicide risk. One forensic case analysis framed the issue bluntly: if self-destructive or suicidal ideations are not recognized during the clinical encounter, and the patient subsequently self-harms or dies by suicide, the treating urologist may face legal liability for failing to diagnose and refer for psychiatric care.16The Canadian Journal of Urology. Forensic implications in self-insertion of urethral foreign bodies
This is not a theoretical concern. The same analysis described a patient whose initial urological evaluation led to a diagnosis of depression, which might otherwise have gone undetected. For urologists, the takeaway is that extracting the object is only the first step. Documenting a basic mental health assessment, asking about self-harm, and making a psychiatric referral are protective for the patient and legally protective for the physician. In the context of earthworm or worm-like foreign bodies, where the object itself may suggest impulsive or psychologically driven behavior, the index of suspicion for underlying psychiatric illness should be higher than for, say, a lost catheter fragment.
Who This Happens To
The demographics skew overwhelmingly male. In the largest published case series, 97% of patients were male, reflecting the anatomical reality that the male urethra is both longer and more accessible for external insertion than the female urethra.4PubMed. Urethral Foreign Bodies: Clinical Presentation and Management The age range is broad, spanning from adolescents to older adults. The median age in the Cook County series was 26, but individual case reports describe patients from their early teens to their sixties and beyond.
Pediatric cases warrant separate attention because the motivations differ. Young children who present with urethral foreign bodies are more likely to have inserted objects out of curiosity or during play, and in tropical regions, accidental leech or organism entry is disproportionately a pediatric problem since children are more likely to bathe naked in open water.5PubMed. Leech infestation in children through body orifices: experience in a hospital in Bangladesh In adults, the autoerotic and psychiatric motivations dominate. Elderly patients who present with urethral foreign bodies sometimes have cognitive impairment or dementia as contributing factors, and their cases may come to medical attention only after significant complications have developed.
How Extraction Works
The approach to removal depends on where the object is and what it is made of. Most urethral foreign bodies can be retrieved endoscopically, using a cystoscope or urethroscope to visualize the object and grasping instruments to pull it out through the natural urethral opening. Soft biological objects like earthworms or leeches are generally easier to extract than rigid items because they conform to the urethral channel and are less likely to cause additional tearing during removal. However, if the object has been in place long enough to trigger stone formation around it, the calcified mass may be too large for endoscopic retrieval. In those cases, open surgical approaches become necessary, sometimes requiring an incision through the perineum or lower abdomen to access the bladder.
For leech infestations specifically, the challenge is slightly different. A live leech attached to the urethral mucosa will resist simple traction because of its suction mechanism. Techniques described in the case literature include applying saline irrigation to dislodge the leech, using endoscopic instruments to detach it, and in the Bangladesh series, performing suprapubic cystotomy when bladder-dwelling leeches could not be reached through the urethra.5PubMed. Leech infestation in children through body orifices: experience in a hospital in Bangladesh Post-extraction management focuses on controlling bleeding from the attachment site and treating secondary infection.
After any foreign body removal, follow-up imaging is recommended to confirm that no fragments remain in the urinary tract. A retained piece of organic material can serve as a nidus for infection or stone formation even after the bulk of the object has been extracted. Patients who present with their first episode are counseled on the risks and, ideally, referred for psychiatric evaluation. Those with a pattern of repeated insertions require more structured psychiatric intervention, though adherence to mental health follow-up in this population remains a persistent challenge in clinical practice.14Psychiatry Research Case Reports. A case report on Urethral Polyembolokoilomania from Sri Lanka-psychiatric perspective – Section: Discussion