Elective Home Surgery FAQ

Elective Home Surgery FAQ This document replaces the 1998 Home Surgery Advice FAQ
Version: 0.01 Date: 01-16-2002
This FAQ is compiled by and copyright (c) 1998-2002 BMEZINE.COM Inc. For more information on heavy body modification, please visit www.bmezine.com or contact us at extreme@bmezine.com
Please note that this is an entirely preliminary version of this FAQ. To complete it, I need YOUR help. If you would like to answer the unanswered questions, expand the ones that are hear, add new questions, or correct errors, please contact Shannon at extreme@bmezine.com

INTRODUCTION
Why home surgery?
What is this FAQ about?
Isn't is "wrong" to write an FAQ on this subject?
How can I judge whether a practitioner is qualified?
I think I'd prefer to see a doctor for my procedure. How can I find one that is willing?
I'd like to seek an underground practitioner. How do I find one?
I think I'd like to do it myself.
SECTION ONE - HOME STERILIZATION
Why is sterilization important?
What is cross-contamination?
Why are gloves important?
How can I create a "clean space" to work in at home?
Do I need to sterilize new (unused) tools?
Can I sterilize using fire?
Can I sterilize using alcohol?
Can I sterilize using bleach?
Can I use a pressure cooker to sterilize my tools?
What about chemical sterilization?
What about an autoclave?
What about single-use tools?
How should I dispose of my used sharp things?
How should I dispose or clean my used tools?
How should I dispose of bloody cause and other procedure waste products?
SECTION TWO - SURGICAL SUPPLIES AND TOOLS
What tools are required for performing basic genital procedures like subincision?
What supplies should be on hand for procedures?
Where can I get my supplies?
SECTION THREE - WOUND CLOSURE
Why do I need to close wounds?
When can I just use bandages or butterflies, and how do I use them?
When can I use glue, and how do I use it?
When can I use sutures, and how do I use them?
SECTION FOUR - ANESTHESIA
What are my basic pain-control options?
Tell me about sedatives, tranquilizers, opiates, and oral pain control?
Tell me about topical anesthetics?
Tell me about local injectable anesthetics?
What is epinephrine?
Tell me about ice?
Tell me about rubber bands?
Tell me about general anesthesia?
SECTION FIVE - LEGALITIES AND ETHICS
What legal risks do I face if I do a procedure on myself and something goes wrong?
What legal risks do I face if I do a procedure on someone else and something goes wrong?
What if I made the person sign a release?
Is it legal for me to possess medical tools?
Is it legal for me to possess anesthetics?
SECTION SIX - TRAINING
How can I learn to do these procedures?
I don't want to go to all that effort. How else can I learn?
I don't want to know anything except how do to procedure XXX. Where can I learn it?
SECTION SEVEN - RISKS
How do I know if a procedure is viable?
How do I know if a procedure is safe?
How can I control bleeding?
Things are looking bad. When should I call the ambulance?
I think something isn't healing right. When should I see the doctor? What should I tell them?
APPENDIX - RESOURCES
What are some publications related to home surgery?
Where can I get medical texts?
Where can I buy supplies?
Where can I buy supplies that won't ask too many questions?

INTRODUCTION Why home surgery?
The "legitimate" medical community has a remarkably limited range of elective procedures that they are able to offer without facing intense scrutiny and potentially sanctions from their peers. As such, there are a myriad of procedures (including atypical implants, transdermal implants, subincisions, silicone injections, castration, and amputation to name only a few) that are unavailable using the Western medical industry.
As such, people are left with a limited number of options including not getting the procedure at all, doing it themselves, seeking the assistance of an "underground" practitioner (possibly medically trained, but more than likely not), or travelling to a doctor in a country where doctors are not as restricted.

What is this FAQ about?
This FAQ is designed to expose readers to some of the issues involved with performing surgical procedures in a non-medical environment with largely untrained practitioners. This document is not intended as a training guide, and in no way does reading a document like this make a person qualified to perform these procedures.
That said, the vast majority of -- and perhaps all -- practitioners serving the body modification community, be they piercers or be they implanters, fall into the category of "home surgeon" in that they are performing what are arguably pseudo-surgical procedures without the support of the medical community. Using the services of these practitioners is still in most cases the safer than doing it yourself, but it is essential to inform yourself as to the issues they are facing so you can better assess whether the risk is worth it.

Isn't is "wrong" to write an FAQ on this subject?
People will be involved in these things whether there is an FAQ on it or not. 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.

How can I judge whether a practitioner is qualified?
Go with the basic assumption that they are not qualified. If they tell you they used to be a nurse, assume they could be lying. If they show you photos of their work, realize that there could be ten times that many people where the procedures didn't go well. Assume that they could be psychos that get off on cutting you. Now, odds are these worries will be baseless, but because there is no industry monitoring or certification, you and you alone must be able to judge their qualities and abilities.
The only way to be able to judge their ability is to do everything you can to fully educate yourself on the procedure you are interested in and all the risks and issues associated with it. At that point you can meaningfully interview potential practitioners and more reasonably decide what the best course of action is.

I think I'd prefer to see a doctor for my procedure. How can I find one that is willing?
First and foremost, you must realize that a doctor (and any ethical practitioner, medically trained or not) will turn you away if they feel you are not mentally stable. Now, you're coming to them asking for a procedure that's well outside of the cultural norm, so you've already got one potential mark against you -- be very sure that you can rationally justify the procedure you're interested in. If you can't, then it might be in your best interest to simply wait and think about it a bit longer.
Before seeking underground routes, you would be advised to first approach some plastic surgeons in your area. Look for those who specialize in breast implants and cosmetic genital enhancement, as they will be most used to unusual requests.
If that fails, there is a network of doctors both inside and outside of the West that are willing to do these procedures. For obvious reasons I'm not about to list their contact information here, but they can be easily found using the existing body modification contact lists on BME, as well as through tradition heavy SM and eunuch channels.

I'd like to seek an underground practitioner. How do I find one?
Assuming that someone who maintains a public profile doesn't offer the procedure you're looking for, just ask around. Local piercing studios may well know people. Local leather and SM shops may know people. Try telling your story on mailing lists and describe why you're interested. While most don't post on mailing lists, many practitioners monitor lists to keep up on what's going on and to meet potential clients.
Whatever you do, don't just blindly go to the first person you find. While the first one might be qualified, they might not. Make sure you know all your options, and then make the best choice. Make sure that the person you've picked out to do your procedure is both technically qualified, and that you are comfortable with them on a personal level. If your gut says no, back out.
Finally, if you're looking for a serious procedure, you should know that an ethical practitioner will be just as worried about you as you are about them. As with a doctor, be sure that you can rationally justify your desire for the procedure.

I think I'd like to do it myself.
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 bad. 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.

SECTION ONE - HOME STERILIZATION Why is sterilization important?
The world is full of all sorts of dangerous microbes (such as bacteria and viruses), as well as any amount of "dirt" that can contaminate a procedure. These things can do anything from the minor (lengthening healing, increasing scarring, damaging the tissue, etc.) to more serious problems (giving you a debilitating incurable disease like Hepatitis or AIDS, to giving you a serious and life-threatening infection, to causing the procedure to fail). It is essential that the procedure be as free of these problems as possible, and proper care for sterilization is an essential part of a responsible procedure.

What is cross-contamination?
Even if you've properly sterilized and cleaned the things you'll be coming in contact with during a procedure, they can still be contaminated. For example, if you handle a clean object, then touch a dirty object, then handle the clean object again, you've just contaminated the clean object. If you need to handle dirty objects, changing gloves at strategic points can stop this contamination. For example, in the above, if you insert a glove change after handling the dirty object, the clean one handled afterwards won't be contaminated.
Be very vigilant of cross-contamination issues, as they are a tiny thing that can undue all the effort you've gone to. It's very easy to accidentally do things like put a tool down on a dirty surface for a fraction of a second and contaminate the entire procedure.

Why are gloves important?
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.

How can I create a "clean space" to work in at home?
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)

Do I need to sterilize new (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 or Hep 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.

Can I sterilize using fire?
No. Fire will not sterilize effectively, and it will damage whatever you are sterilizing, as well as leaving soot all over the item. This is an entirely ineffective way to sterilize.

Can I sterilize using alcohol?
No. Alcohol is not strong enough to kill most of the microbes we are worried about. While it's fine for things like wipe downs, it is utterly inadequate for sterilizing tools.

Can I sterilize using bleach?
Yes, in theory you can use bleach to sterilize your tools. Your local needle exchange program can give you full information on doing this and most will even provide you with a kit. (more coming soon)

Can I use a pressure cooker to sterilize my tools?
Yes, you can use a pressure cooker to emulate an autoclave, but pressure cookers are not really designed for the precision operation that is required, and their effectiveness cannot be guarantied. (more coming soon)

What about chemical sterilization?
Chemical sterilization using gluteraldehyde-based chemical agents is an effective way to sterilize in a home studio environment, but care must be taken to follow the instructions precisely. A common mistake people make is not leaving the tools in the chemical bath long enough because they contaminate the bath by adding additional tools part way through the cycle.

What about an autoclave?
Now you're on a good track! An autoclave is the single most effective sterilization tool available to the home studio. Used autoclaves are not hard to find for well under $500, and there is no excuse for not using one. That said, it still has to be used correctly. The most common mistake is over-packing the autoclave; when you do this, the steam is not able to permeate properly and complete sterilization is not achieved. (more coming soon)

What about single-use tools?
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.

How should I dispose of my used sharp things?
Tools should be disposed of using an approved sharps container and then disposed of as your local laws demand (as 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.

How should I dispose or clean my used tools?
(coming soon)

How should I dispose of bloody cause and other procedure waste products?
This 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.

SECTION TWO - SURGICAL SUPPLIES AND TOOLS What tools are required for performing basic genital procedures like subincision?
(coming soon)

What supplies should be on hand for procedures?
(coming soon)

Where can I get my supplies?
(coming soon)

SECTION THREE - WOUND CLOSURE Why do I need to close wounds?
(coming soon)

When can I just use bandages or butterflies, and how do I use them?
(coming soon)

When can I use glue, and how do I use it?
(coming soon)

When can I use sutures, and how do I use them?
(coming soon)

SECTION FOUR - 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 that their life has been placed at significant risk. Realize as well that 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).
What are my basic pain-control options?
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.

Tell me about sedatives, tranquilizers, opiates, and oral pain control?
(coming soon)

Tell me about topical anesthetics?
Topic 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 www.bmeshop.com

Tell me about local injectable anesthetics?
(coming soon)

What is epinephrine?
(coming soon)

Tell me about ice?
(coming soon)

Tell me about rubber bands?
(coming soon)

Tell me about general anesthesia?
General anesthesia is extremely dangerous and requires extensive training. Even though it's not particularly hard to get the drugs and equipment, the odds of killing your client would be unacceptably high. In addition, there is no procedure that you should be doing in a "home surgery" context that requires general anesthesia. If you want to experiment with general anesthesia on a recreational level, you can contact kinky medical professionals through heavy SM clubs.

SECTION FIVE - LEGALITIES AND ETHICS What legal risks do I face if I do a procedure on myself and something goes wrong?
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)

What legal risks do I face if I do a procedure on someone else and something goes wrong?
If the courts decide that what you did is a medical procedure, and that you are not legally "allowed" to perform it, you can at a minimum be charged with various practicing medicine without a license. Further, you can be charged with anything ranging from assault to murder depending on what went wrong.

What if I made the person sign a release?
First, you must have the person sign a release form of some kind. This release form must at a minimum show that your client acknowledges that they understand that you are not a medical professional. It should also include every possible risk you know of, and have them sign to show that you informed them of them.
All that said, all the release will ultimately show to the courts if that's where you find yourself is that your client entered into the procedure with an understanding of what was going on, and that you didn't mislead them. It will not protect you from prosecution for complications during or after the procedure in most countries.
(more on this subject soon)

Is it legal for me to possess medical tools?
In most places it is legal for a private citizen with no medical training to 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)

Is it legal for me to possess anesthetics?
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)

SECTION SIX - TRAINING How can I learn to do these procedures?
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.
(more coming soon)

I don't want to go to all that effort. How else can I learn?
(coming soon)

I don't want to know anything except how do to procedure XXX. Where can I learn it?
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.
(more coming soon)

SECTION SEVEN - RISKS How do I know if a procedure is viable?
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 is quite common on an anthropological level and is 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.

How do I know if a procedure is safe?
Generally, you don't. 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.

How can I control bleeding?
(coming soon)

Things are looking bad. When should I call the ambulance?
(coming soon)

I think something isn't healing right. When should I see the doctor? What should I tell them?
(coming soon)

APPENDIX - RESOURCES What are some publications related to home surgery?
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).

Where can I get medical texts?
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.

Where can I buy 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.
(more coming soon)

Where can I buy supplies that won't ask too many questions?
Well, 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.
If you'd like to support the authors of this FAQ, you can get almost anything through www.bmeshop.com -- if there's something specific you need that's not listed there, just ask them. If for some reason you don't want to deal with BMEshop, you can find no-questions-asked medical supplies through most serious SM clubs.

This document is copyright (c) 1998-2002 BMEZINE.COM Inc. Please be aware that the authors of this document have no officially recognized medical training. Before undertaking any procedures, please consult your physician.