DIY Surgical Mods
Warning: This document is not written by medical professionals, and may contain numerous errors. It is intended as a starting point and introduction for those interested in this subject, but is by no means complete. Readers are strongly urged to do as much research of their own as possible, as well as speaking to their doctor before seeking out any such procedures.
Having this document hopefully will make people think a bit harder about what they're doing so they can make the safest possible decision. In addition, it is BME's belief that, ultimately, a person has total authority over their body, and, given a sound mind, they have every right to pursue any body modification dreams they may have.
Please be aware that the authors of this document have no officially recognized medical training. Before undertaking any procedures, please consult your physician.
Given that most of the surgical modifications sought out by body modification enthusiasts aren't currently offered by doctors and that qualified practitioners are sometimes difficult to locate, many have chosen to go ahead and perform their own surgical procedures such as tongue splitting, meatotomy, subincision, and even more serious procedures such as castrations and implants.
This is certainly a valid option, while not an "officially" recommended one. However, it is important that you are competent to do the modification. Do not underestimate how difficult it is to work on yourself—balance the risks of self-modification with the benefits.
At an utter minimum, have a friend assist you or at least be there to help should things go badly. Alternately, let someone know that you're doing the procedure so there's someone to call an ambulance if you don't check in with them. The big risk with doing procedures on yourself is how to handle unforeseen complications. It's not as if you can give yourself CPR if you pass out for some reason.
It goes without saying that you can put yourself at serious risk of some major complications such as bleeding and infection by performing your own procedures, but with extensive education and preparation, there is an amazing success ratio for these at-home procedures.
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Legality
In general, it is not illegal to perform procedures on yourself, assuming you are able to legally possess the supplies you used, and there are no criminal charges I know of that could apply in a failed self-procedure. That said, if you require medical assistance from the government, they may require that you speak with a psychiatrist. If they determine that you are mentally unfit and are a danger to yourself, the state can and will commit you for psychiatric treatment. (more coming soon)
Possessing Medical Tools
In most places it is legal for a private citizen with no medical training to acquire with no questions asked (from gray suppliers) and own most medical supplies. It is, however, usually not legal for them to perform medical procedures—it should be mentioned though that "medical procedure" is a very gray term, and it is unclear as to exactly how the courts would interpret all procedures. (more coming soon)
In many places it is legal for a private citizens to possess anesthetics, and in many other places it is illegal on some level— you should definitely check your local laws. Actually using anesthetics on others is usually not legal for non-medically recognized practitioners. (more coming soon)
Training
Realistically, the best way to learn how to safely perform these procedures is through a combination of intensive schooling and hands-on training. The most obvious way to learn how to do this is by going to medical school. I know that's not what you wanted to hear, but the truth is that these subjects are enormously complex and really should be treated with this level of respect. Alternately, excellent hands on medical training—essentially advanced first aid training—is available through the military as well as through civilian groups. Even taking a starter first aid course through St. John's Ambulance, the Red Cross, or a similar group will take you a long way to being able to handle most of what gets thrown at you.
While it is true that many procedures such as meatotomies and genital beading are very simple procedures, realize that it's usually the complications that are much more difficult to handle than procedure itself. Now, this means that if no complications occur, you can probably do the procedure knowing almost nothing. It also means though, that if complications do occur, you could find yourself in a situation that you are dramatically unprepared for.
Sterilization
For more information, please see Sterilization
Gloves
Gloves are important for two primary reasons. First of all, they allow you to control cross-contamination as above. Equally importantly though, your hands—and your entire dermis—are absolutely saturated with bacteria and viruses of all kinds. Some of these microbes are "friendly," but many are not. Your skin is pretty good at protecting you from them, but assuming that the procedure breaks the skin, you lose most of that protection.
It is very strongly recommended that gloves be used, even if you're just working on yourself.
Clean space
To even consider setting up a clean space, everything in that space must be cleanable, which means it must have a hard nonporous surface. That means carpeted spaces are out. That means doing procedures in bed is out. (more coming soon)
(Unused) Tools
The tools are coming in direct contact with the inside of your body. Their sterility should be of utmost concern. While the odds of a new tool being exposed to AIDS, Hepatitis C or other diseases are slim to none, new tools will certainly be contaminated with things like dirt, skin surface bacteria, and industrial cleaners.
While it is strongly recommended that full sterilization be used even for brand-new tools, if the tools are being used only once and then disposed of, one would probably face only negligible risks by omitting full sterilization in this very specific case.
Single use pre-sterilized tools are an excellent compromise for those who don't need to do procedures on a regular basis, and are not interested in investing a means to sterilize tools. Single use forceps and other tools are available from most medical suppliers —they are often actually more expensive than their metal counterparts, but remember that they are coming sterilized.
Disposal
Tools should be disposed of using an approved sharps container and then disposed of as your local laws demand (ask a hospital in your area if you're not sure). In a worst-case scenario, you can improvise a sharps container using a hard plastic bottle, but this isn't recommended.
The disposal of bloody cause and other procedure waste products will vary from area to area. You can ask a hospital in your area for the specifics, but if could be anything from throwing it out in a sealed bag with your household waste to treating it as fully biohazardous material.
Supplies
First of all let me urge anyone looking for supplies to first be totally sure that they won't hurt themselves or others with these supplies. Then, you should make sure that the supplies you're buying are at least gray legal in your area; it's not worth getting arrested for something as minor as possession of medical supplies.
In many areas, you can buy medical supplies straight from the source (that is, from medical wholesalers). Just realize that when you're talking to them, it would not be in your best interest to tell them what you plan on doing with the supplies (even if it's perfectly legal). If you tell them you plan on doing a home procedure, they may feel that they would share liability should something go wrong and cancel the order.
In addition, many of the supplies used in home surgery are readily available through sports medicine and veterinary medicine suppliers, not to mention that many of the sundries (like gauze, non-stick pads, butterfly sutures, etc.) are available at pharmacies.
Anesthesia
First of all, it should be noted that while modern anesthetics are remarkably safe, it is not at all uncommon for some people to have violent and life-threatening allergic reactions to them. Be aware that if a person is exposed to anesthetics and has such a reaction in a non-medical environment, their life has been placed at significant risk. Realize as well, if a person who can not legally perform the procedure is doing the procedure, significant criminal charges could apply (see the legal section for more on this).
Methods available include nothing (just grit your teeth and bear it), ice, rubber bands (vasoconstriction and exsanguinations), oral pain control, topical anesthetics (like EMLA), injectable anesthetics, and general anesthesia.
Topical Anesthetics
Topical anesthetics in cream form are available in many countries. They work by using penetrating agents to pass prilocaine and similar anesthetics through the skin, anesthetizing it superficially. EMLA cream is one of the widely available brandnames, and is available over-the-counter in Canada. This product was developed for use on children and is remarkably safe.
In most parts of the United States, topical anesthetics are by-prescription, but many doctors are willing to prescribe it if you tell them you're going in for a piercing or tattoo and are worried about the pain. In addition, it is possible to order EMLA from suppliers such as BMEshop[1].
Injectable Anesthetics
A hypodermic syringe (which tend to be illegal to possess but easy to obtain if one claims to be a diabetic) is used to inject the numbing agent in the area to be numbed. Lidocaine seems to be a favorite choice.
Sometimes the injection hurts as much as the procedure (which might be unbearable without it). Injecting into thin tissue like the scrotum as one is trying to suture up can be as painful as simply suturing without an injectable.
Epinephrine
(coming soon)
Ice
(coming soon)
Rubber Bands and Clamps
By restricting blood flow and overstimulating nerves in the area, rubber bands and clamps can help numb an area. Clamps on a tongue about to be split can be most unbearable, but one is more focused on the pain from the clamps than the scalpel.
By restricting blood flow, clamps can help with controlling bleeding long enough for clotting to start.
Risks
Generally, you can never really know whether a procedure is safe. Common sense and research can certainly let you make an educated guess, but there are a million things that can, in theory, go wrong, even with top doctors, so you should definitely consider the realistic safety level very carefully.
Procedure Viability
The easiest way to see if something is possible is to see if it's been done before. Resources like BME catalog the experiences of thousands of individuals performing these procedures—read their stories and pay attention, especially to the negatives. Realize though, that just because one guy got something to heal doesn't mean yours will do as well. A more realistic way to judge the viability of a procedure is to see if it has a historical context. Glans splitting and subincision are quite common on an anthropological level, and are practiced by many cultures; if it was terribly dangerous, one can assume that these societies would not choose to do it to their young men.
Either way, educate yourself as best you can, use common sense, and if you're not sure about something, always err on the side of safety.
Bleeding
Bleeding may or may not be serious, but one should be ready for controlling bleeding (ice, a method of cauterization, a way to the hospital, etc.). Some mods by their very nature will produce a lot of blood, while others not so much (although a little blood mixed with a lot of saliva can look pretty shocking). Blood and anything blood gets on should be considered contaminated and biohazardous.
Scarification should not generally produce a worrisome quantity of blood as it only affects the skin.
Tongue splitting can produce a lot of blood-colored saliva from a little amount of blood. A lot of blood would not be a good sign. If you are planning on using electrocautery to handle bleeders, be sure to test the device first since suturing in a bloody mouth is no fun.
Castration will generally be very bloody. It's not something to attempt alone or without careful planning. Failing to adequately attempt to control bleeding may result in a scrotum full of congealed blood that may take a month to empty on its own and may be too painful to touch. Squeezing congealed blood (which looks and feels a lot like grape jelly) out of a scrotum can be painfully amusing and something to avoid according to one contributor.
When You Need an Ambulance
The worst that could reasonably happen (from a medical standpoint) would be stabilization/reversal of the mod, a stay in the psych ward and loss of all piercings (and bills, lots of bills). A second should be present just in case you cannot determine you need an ambulance since you could be feeling quite fine from an adrenaline rush but be on the verge of shock or passing out.
When You Need a Doctor
Resources
Other than BME, there are no regular publications about home surgery. That said, there are many online mailing lists that discuss the subject peripherally (for example, the non-fiction eunuch issues mailing list).
Inexpensive used medical texts, including genital surgery texts, cosmetic surgery texts, or even just general surgery guides, are sold regularly on eBay and other online auction sites. Don't be surprised when you see a five hundred dollar text selling for twenty dollars. These medical texts tend to contain exhaustive procedural photos and instructions and are an incredible investment. In addition, almost every major city has at least a small university medical library. If you're not a student, you obviously won't be able to check out the books, but usually ID isn't checked at the door, and you should be able to stay there and read (and photocopy) as long as you want. You can also spend time at the university bookstore and browse at least the beginner medical student textbooks which do an excellent job of giving you an overview of the issues involved.