Methods, practices, and complications related to the use of artificial penile nodules within the French Guiana penitentiary.

Background: Artificial penile nodules (APNs) are small, handmade objects inserted under the penile skin, a practice deeply rooted in the prison environment of French Guiana, raising significant concerns related to sexual health, including complications and an increased risk of sexually transmitted infections (STIs).

Aim: The primary objective of the current study was to investigate APN practices, methods, and complications in prison and to identify risk factors for complications among APN users and their sexual partners.

Methods: This cross-sectional study was conducted among adult male detainees in June 2023 at the French Guiana Penitentiary (FGP). Eligible participants completed an anonymous 47-question survey addressing sociodemographic data, APN practices, and sexual health. Facilitators played a critical role in distributing and collecting the questionnaires, which were available in five languages to accommodate the prison's population ethnogeographic diversity. Data analysis was conducted using logistic regression to identify risk factors associated with complications.

Outcomes: Outcomes included the prevalence of APN use among detainees, the proportion of individuals experiencing complications, the association between APN characteristics (number and placement) and partner-related complications, as well as the rates of condom breakage and self-reported STI history.

Results: Among 779 eligible detainees, 132 participated (17%). The majority were under 35 years old (67%), and 69% reported having APNs, with a median of 5.2 nodules per user (range: 1-22). The main motivation for APN use was enhancing partner satisfaction (60%), while 5% cited intent to harm. Complications were reported by 25%, including pain (52%), bleeding (41%), and infections (35%). Partner-related complications (pain or bleeding) were significantly associated with having five or more APNs and placement in the foreskin of the penis.

Clinical implications: Given the high prevalence of APNs in the prison setting and their associated health risks, targeted health education and harm reduction strategies are essential to mitigate complications and promote informed decision-making among detainees.

Strengths and limitations: The main limitation of this study was its reliance on self-reported questionnaires completed in cells, which may have affected confidentiality, response accuracy, and participation due to prison dynamics and literacy barriers. However, the approach provided valuable insight into a stigmatized topic, and collaboration with facilitators and staff helped achieve meaningful participation.

Conclusion: APNs are deeply rooted in prison culture in French Guiana but pose significant health risks. Findings underscore the need for targeted health education to address these risks, particularly focusing on reducing partner-related complications and promoting informed decision-making about APN practices.

Highlights: Despite their widespread use, APNs pose significant health risks, including pain, infections, and complications for sexual partners, with nearly half of users reporting partner-related issues.This study underscores the need for targeted health education interventions to address these risks and promote safer practices within the penitentiary system.Nearly 70% of detainees reported having artificial penile nodules, with a median of 5.2 nodules per user, highlighting the prevalence of this practice in French Guiana's prisons.A significant link was found between having five or more nodules and partner complications, such as pain or bleeding, emphasizing the impact on sexual health.