In this minute video Dr. Teresa Tam demonstrates insertion and removal of the ring and Gellhorn pessaries and illustrates proper technique for estimating pessary size. Skip to main content. OBG Manag. Next Article: Pessaries for vaginal prolapse: Critical factors to successful fit and continued use.
The present study examined whether i scape removal is only associated with the second palpal insertion one-action hypothesis or ii two contralateral palpal insertions facilitate FGM, with each insertion cutting the basal part of the scape halfway two-actions hypothesis. When a female accepts courtship, the male inserts one of its pedipalps into one of the genital openings of the female. All females were found on moulting webs, indicating that they had just completed the final moult Helicopter ass or were ready for the final moult subadult [ 26 ]. The unique nature of the presentation, along with the astonishing radiographic Anabolic gangbangs, can lead to a breach of privacy and dissemination of the digital photographs by cell phones and into social media sites. Soon, the second virgin female was aware of the courting male, and accepted its first, but the male's second, insertion. Comparison of the morphology of genitalia, especially the basal part of the scape Genital insertions females and tegular apophysis in males, among species that do and do not exhibit FGM might provide information about the evolution of genitalia, Genital insertions details on the mechanism of mutilation. The method of object removal is determined by the presence or absence of a surgical abdomen and the need for general anesthesia.
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Some male spiders exhibit female genital mutilation behaviour FGM by removing the female genital appendage scape to control the mating frequency of females.
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Some male spiders exhibit female genital mutilation behaviour FGM by removing the female genital appendage scape to control the mating frequency of females. Female spiders have two, i. Thus, males must complete at least two palpal insertions to fill both spermathecae, before FGM.
The present study examined whether i scape removal is only associated with the second palpal insertion one-action hypothesis or ii two contralateral palpal insertions facilitate FGM, with each insertion cutting the basal part of the scape halfway two-actions hypothesis. Experiments in which females were replaced after a male had made the first insertion did not support the one-action hypothesis, because scapes remained intact after the newly introduced virgin females received their first palpal insertion, which was the second insertion by the males.
In comparison, mating experiments using two half-eunuchs i. In the majority of taxa, a female often mates with multiple males [ 1 , 2 ]. However, this action reduces male fitness; thus, to secure paternity, males have developed various strategies to inhibit females from mating with multiple males, including guarding females [ 5 ], injecting chemical substances to lower female re-mating tendency [ 6 ] and mating plugs [ 7 ].
Another way to prevent females from mating multiply is through female genital mutilation FGM by males. For example, FGM has been described in two orb-web spiders, Cyclosa argenteoalba [ 8 ] and Larinia jeskovi [ 9 ].
In these species, virgin females have a small projection, called a scape, on their external genitalia epigynum [ 10 ]. The scape is essential for successful mating. In FGM, the scape is removed from the epigynum during mating, preventing the success of subsequent genital coupling.
Thus, mutilated females cannot mate with additional males. FGM is a powerful way in which males can inhibit females from mating with multiple partners, and thus ensure full male paternity. For instance, mate guarding might reduce the glycogen reserves of males in stream-dwelling isopods [ 12 ].
Some male spiders form mating plugs by breaking their pedipalps and leaving breakages in the copulatory openings of females [ 13 , 14 ]. Male Nephilengys malabarensis also detach their entire pedipalp, which continues sending sperm into a female. All these males lose all their future mating opportunities. Male garter snakes adjust the size of mating plugs according to the size of the females [ 19 ], suggesting that the production of these plugs is costly.
Nevertheless, males often fail to monopolize their partnered female [ 20 — 22 ]; thus, monandry is relatively rare [ 23 ]. Cyclosa argenteoalba is a diurnal spider that occurs in Japan, Korea and China [ 24 ]. This species builds vertical orb webs. The male spider has two pedipalps i. On mating, a male makes a mating thread and sends courtship signals by tapping and jerking the thread with its legs.
When a female accepts courtship, the male inserts one of its pedipalps into one of the genital openings of the female. Thus, at least two palpal insertions are required to fill both spermatheca with sperm, which is considered to lower the risk of insufficient sperm being available at oviposition [ 25 ]. In fact, C. When the insertion successfully ends, the pair separates, and the male repeats its courtship behaviour to make the second insertion using the other pedipalp.
The scape typically remains on the epigynum during the first insertion; however, it is absent after the second insertion [ 8 ]. This process is logical because if FGM occurred at the first insertion, males could not complete the second insertion, and the second spermatheca would remain empty. Here, we examine if selection acts on C. This question will give us invaluable insights into the evolutionary process and selective mechanisms of FGM.
Namely we test two hypotheses. The one-action hypothesis predicts that spiders implement no actions to mutilate the scape during the first insertion, with scape-removal behaviour only being associated with the second insertion.
Alternatively, the two-actions hypothesis predicts that a male destroys only one side right or left of the scape at the first insertion. Once both insertions right and left are complete, the destruction of the scapes on both sides facilitates successful FGM.
The rationale for this hypothesis comes from a phenomenon recorded in L. Thus, this study aimed to examine which of these two hypotheses is valid in C. I collected both adult and subadult female C. All females were found on moulting webs, indicating that they had just completed the final moult adult or were ready for the final moult subadult [ 26 ]. Subadult females were allowed to moult into adults. By following this procedure, I ensure that all adult females were virgins prior to the experiment.
Individual spiders were identified by variation in the abdominal markings [ 27 ] and the location of their webs. The observation area was not enclosed, but was surrounded by residential buildings. The nearest natural habitat of C. Adult males, for which the mating history was not known, were also collected from the same sites and were maintained in separate vials with wet cotton.
When a male successfully inserted one of its pedipalps and completed sperm transfer I could not determine whether the right or left pedipalp was used, due to the small size of the spiders and short duration of insertion , females were removed from the web.
After the male resumed courtship, a different virgin female was introduced to the hub of the experimental web from a nearby web. Soon, the second virgin female was aware of the courting male, and accepted its first, but the male's second, insertion. The male did not exhibit any further mating behaviour, and left the web. Adult males were anaesthetized with CO 2 , and the tip of one of their pedipalps was cut off with fine scissors under the microscope. Preliminary observation confirmed that manipulated males could only make one insertion during a single mating event, indicating that the operation successfully disabled the manipulated pedipalp.
Which pedipalp was removed right or left for each male was randomly determined. Thirty-two experimental females were assigned to four groups. Females from the first group were coupled with a male that had an intact right pedipalp termed right-hand male, hereafter. After receiving one palpal insertion from the first male, the female was coupled with another male with an intact left pedipalp hereafter, left-hand male , and received the second insertion. Females from the second group were coupled with a left-hand male first, and then with a right-hand male.
The females in the third and fourth groups were coupled with two right-hand and left-hand males, respectively. As a result, one right-hand male was used twice as the second male for females in the second and the third groups. All other males were used only once. After a female received two insertions, the presence of the scape was inspected under the microscope. The mutilation rate was similar between the first and the second groups, and between the third and fourth groups. As a result, data from the first and second groups were pooled as the contralateral insertion group, and the data from the third and fourth groups as the ipsilateral group.
In the female exchange experiment, none of the second females lost their scapes. In the half-eunuch experiment, 10 of the 15 females from the contralateral insertion group and four of the 17 females from the ipsilateral insertion group lost their scapes. In comparison, the half-eunuch experiments showed that the incidence of FGM was significantly higher in females that received two contralateral insertions than in females that received ipsilateral insertions.
In the half-eunuch experiment, some females from the ipsilateral insertion group lost their scapes. A previous study showed that C. Thus, cutting both sides of the scape might not always be required for FGM. As argued in the study on L. In the typical mating ritual of C. This body rotation might generate a twisting force, which, if strong enough, might cause genital mutilation, even when only one side of the scape is cut. The necessity of additional action is logical because if the scape was removed at the exact timing of the second slashing, which is considered to occur when the pedipalp clasps the scape, subsequent palpal insertion would fail.
FGM seems to require two insertions. Two-actions FGM might be essential for the efficiency of securing paternity because when a male has made only a single palpal insertion, failing to insert the palp a second time, the scape remains attached to the female.
This event might be expected when a female cannibalizes a male after the first palpal insertion or when the mating sequence was interrupted after the first insertion by a disturbance, such as sudden change in weather, the destruction of the web or when two males simultaneously court the same female.
If males only mutilated the scape during the second insertion, as expected by the one-action hypothesis, the scape of a female that had received only one insertion would remain undamaged.
Consequently, a second male could make two successful palpal insertions. Assuming that two males inject a similar amount of sperm per insertion, the sperm of the first male would represent one-third of the sperm mixture.
By contrast, if the male cut the scape halfway during the first insertion, as expected by the two-actions hypothesis, the opportunity for a second male to make two palpal insertions would be lowered. Assuming that males exhibit no preference in the use of their pedipalps, the second male might insert its pedipalp into a contralateral genital opening. Then, the scape would detach, preventing the second insertion. Without cryptic female choice, in this instance, the paternity share of the first male would be raised to half.
Thus, cutting the scape halfway is considered beneficial to secure paternity, even if this action alone does not lead to mutilation. FGM appears to be related to sexual conflict. Under sexual conflict, males often enforce costs on their mating-partner females and females exhibit counter-adaptations [ 28 , 29 ], and theoretical study revealed that FGM may evolve even when females suffer fecundity costs [ 30 ].
In some insects, males damage the internal genitalia of females in copula and females resist behaviourally to this harmful copulation [ 31 , 32 ]. In Cyclosa , some species other than C. Comparison of the morphology of genitalia, especially the basal part of the scape in females and tegular apophysis in males, among species that do and do not exhibit FGM might provide information about the evolution of genitalia, including details on the mechanism of mutilation.
I thank Dr Keizo Takasuka and Dr Atushi Ushimaru for providing suggestions and assistance in conducting the half-eunuch experiment.
The experiments were performed in accordance with the guidelines for ethological studies from the Japan Ethological Society. I am the sole author of this study and conducted all the work by myself. National Center for Biotechnology Information , U. R Soc Open Sci. Published online Nov Kensuke Nakata. Author information Article notes Copyright and License information Disclaimer.
Author for correspondence: Kensuke Nakat e-mail: pj.
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Genital insertions. Embed Video
Anorectal and urethral foreign body insertions polyembolokoilamania are not infrequent presentations to the ED. The motivations behind these insertions vary, ranging from autoeroticism to reckless behavior. These insertions can lead to major complications and even death. Though ED staff members are used to the unpredictability of human behavior, foreign body insertions bring a mixture of responses from the staff, ranging from awe and incredulousness to anger and frustration.
A year-old man presented to the ED for evaluation of a foreign body in his rectum. He admitted to placing a beer bottle in his rectum, but was unable to remove it at home. The staff reported that the patient was previously seen in the ED for removal of a vibrator from his rectum. Radiographic evaluation in the form of an acute abdominal series was obtained and confirmed a beer bottle in the rectum Figures 1 and 2.
A year-old man presented to the ED after he inserted a pen cap into his urethra to aid in obtaining an erection. A pelvic X-ray was obtained and showed a radiolucent structure in the penis Figure 3.
The patient was admitted to the hospital and taken to the OR by the consulting urologist. Using a rigid cystoscope and flexible graspers, the pen cap was removed from the proximal urethra under monitored anesthesia control. The procedure went without any complications. A psychiatrist was consulted, and during the encounter, the patient admitted that his behavior was pathological. He revealed that he was a victim of child abuse and reported he had been having mixed emotions of anxiety, guilt, and embarrassment because of his behavior.
Foreign body insertions are seen in patients with a wide variety of backgrounds, ages, and lifestyles. Approximately 80, cases of foreign body ingestion are seen annually in children under age 20 years. The earliest published report of a rectal foreign body insertion was in by Smiley. Complications, however, can result from the process of insertion, removal, or from the contents introduced into the orifice. Any sharp object can injure the examining physician if this is not done prior.
All examinations should be chaperoned. Additionally, resulting sepsis should be managed with the same standards as any other septic patient. The method of object removal is determined by the presence or absence of a surgical abdomen and the need for general anesthesia.
The location and shape of the object, however, may not equate with successful retrieval. Any attempts at transanal removal require optimal patient relaxation, which can be achieved via procedural sedation. The patient should be placed in a lithotomy or left lateral decubitus position to allow palpation of the object in the lower gastrointestinal tract. From here, several methods of removal can be employed.
Blunt objects can be grasped and removed by a gloved hand or with a clamp. A Foley catheter can also be passed alongside the object and the balloon inflated above the foreign body to aid in extraction as the Foley is pulled out slowly.
Once the foreign body is successfully removed, follow-up imaging or postextraction endoscopy is warranted. Sexual exploration, efforts at contraception, transport of illicit drugs, assault or sexual violence, and accidental insertion have all been described as reasons for genitourinary GU insertion.
Aggressive treatment should be undertaken because even when the penis appears dark or necrotic, salvage rates have been high. Complications include urinary tract infections, hematuria, urinary retention, urethral tears, abscess, ascending GU infections, and diverticula and fistula formations.
Removal of urethral foreign bodies typically is done in conjunction with a urologist. A cystoscopic procedure is usually successful in removing the foreign body and is an effective method to minimize urethral and bladder injuries.
When patients realize they are unable to remove the inserted object, some present immediately to the ED for evaluation. Interestingly, others may wait up to 2 weeks after insertion before seeking help. As a consequence, these patients may not readily come to the ED or if they do come, may not be open to conversation and hide the true reason of why they came in the first place.
Therefore, creating a nonjudgmental environment is essential, even when the presenting story appears to be fabricated. A psychiatric evaluation should be obtained in the ED, or if the patient is admitted, during hospitalization.
Psychiatric behavior leading to insertions can be unmasked, treated, and harm-reduction strategies can be taught and instituted. Experienced ED staff members are used to the unpredictability of human behavior.
However, patients who present with foreign body insertions can elicit a mixture of responses, ranging from awe and incredulousness to anger and frustration. It is not unusual for staff members to not understand or recognize their own reactions. The unique nature of the presentation, along with the astonishing radiographic images, can lead to a breach of privacy and dissemination of the digital photographs by cell phones and into social media sites.
Ensuring privacy, professionalism, and empathy can go a long way to helping these patients. Patients with foreign body insertions challenge the ED staff, as the presenting complaint not only tests the collective technical know-how of the staff, but also their emotional competencies. A nonjudgmental and open-minded approach is crucial, with the tone set during triage.
Coordination with surgical specialties should be done early to ensure safe removal and to identify and manage complications. Psychiatric evaluation should be strongly considered prior to disposition in an attempt to prevent future recurrences. Skip to main content. Foreign Body Insertions: A Review. Treating patients who present with foreign body insertions requires a nonjudgmental and open-minded approach. Emergency Medicine. Author s : Alan Lucerna, DO. Case 1 A year-old man presented to the ED for evaluation of a foreign body in his rectum.
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