Case reportWhile eating lunch a 70-year-old man began coughing andexperiencing labored breathing. His guest called anambulance. When the ambulance officers arrived theyfound the patient pulseless and started cardiopulmonaryresuscitation, but were unable to revive him. The Prose-cutor ordered a forensic autopsy to discern if this case wasan autoerotic death/sexual asphyxia or a natural death, asthe man was known to have a very unusual piercing andpornographic material, including several photographs ofhis genitals, was found in his house. At autopsy, theexternal examination of the genitals revealed that the twocorpora cavernosa were separated at the base of the penis(Fig. 1) and surrounded by two golden rings that enclosedthe testicles (Fig. 2). Another golden ring was placedaround the external urethral meatus and the right hemi-gland (Fig. 3).The urethra was interrupted (Fig. 4) and itslumen was encircled by scar tissue, while the penile urethrawas patent (Fig. 5). A thin golden necklace was insertedinto the shaft of the penis and wrapped around the base(Figs. 1, 2). Internal examination revealed the presence offood (pasta) in the airways, from the larynx to the mainbronchial bifurcation. Toxicological analysis revealed ablood alcohol concentration of 1.2 g/l. The cause of deathwas choking due to food aspiration.DiscussionPiercing is the act of creating a fistula-like tract, or simplyan opening in the body, in which decorative ornamentsmay be worn [1]. Earrings have been worn from the earliesttimes, but over the past 30 years increasing numbers ofpeople have single or multiple piercings almost anywherethrough the skin [2]. The sociological importance of thisphenomenon is that virtually every culture has some formof body modification, including tattooing and piercing,which represent the most common examples. Piercing isassociated with many medical problems, i.e. local infec-tion, sepsis, superficial cervical lymphadenopathy, contactdermatitis, edema and hematoma formation, exuberantgranulation tissue, and keloid scars [3, 4].Implantation of penile pearls, penile tattooing, andpiercing represent different forms of genital modifications inmen [1, 5]. Genital piercings commonly involve the glans orthe skin of the penis and scrotum. The motivation for genitalpiercing varies greatly from one individual to another, andmay involve provocation, rule violation, self-expression, riteof passage, or the need to increase self-esteem. Finally, theassociation of genital piercing with certain psychopatho-logical or antisocial behavior suggests a connection betweenerotic piercings and sadomasochism and fetishism [3].Genital piercings may pass through the penile urethra,producing urinary flow changes. These are represented byPrince Albert piercings, Dolphin piercing, Ampallang(horizontal through the glans), and Apadravya (verticalthrough the glans) [1, 2]. Piercing, as well as inserting