Catheter Play

by Tom A Gordon

Table of Contents

• Introduction
• What's the Thrill?
• What to
  • The Catheter
    • Construction of the Foley Catheter
    • Sterility
    • Sizes
  • Other Equipment for Catheterization
• Catheterization Procedure
  • Insertion
  • While the Catheter is in
  • Removal
• Health and Safety Problems
  • Incorrect Insertion
  • Valve or Balloon Failure
  • Infection

Introduction

The term catheter (cath) can refer medically to any tube which is inserted into the body to give access to an internal organ from outside. But in SM the term is most likely to refer to a tube inserted into the urethra to access the bladder. This sort of catheter is usually made of rubber, occasionally of plastic, and frequently has some form of device to hold it in place.

Regretfully, so far this briefing only covers male catheterization. Women's catheters are shorter, for the shorter urethra, and have their own difficulties of insertion, since the urethral opening is harder to find -- indeed there may be multiple ones. Women are also even more prone to infection. Some of this briefing may be of relevance and interest to women, but the technical aspects are largely inapplicable.

A word of caution: This kind of play is not something you should engage in with someone who is inexperienced or who does not understand all the necessary precautions. Carelessness can result in infection, injury, or other traumatic problems. You should be introduced to this kind of play in the right setting by an experienced, careful person who cares enough about you to exercise all the cautions set forth herein. Even an experienced person should get an extra catheter and practice all of the steps below before trying to insert a cath -- especially the steps involving inflation and deflation of the balloon.

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What's the Thrill?

One aspect of catheter play is the physical sensation and psychological effect of having an object inserted into the urethra, which is strangely sensitive. Catheter games can also involve medical imagery, piss play and the peculiar penetrative vulnerability of having an object inserted deep inside the body, into what is in actual fact an internal organ.

The biggest thrill for most people, though, is most likely control. Catheterized people have no control over their urinary function: if the catheter is left open, the bladder will drain completely and continue to drain as more urine is produced. If the tube is clamped off, they cannot piss, even if they wish and need to.

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What to Use

The Catheter

There are several kinds of catheters, usually named after their inventor or on the basis of the kind of tip they employ. The best catheters are made of latex rubber coated with Teflon, which makes them very smooth when lubricated. Some catheters are made of plastic which becomes very flexible at body temperature; these are usually little more than simple tubes with a slight 'funnel' at one end. By far the most common type for use in sex play, and the type to be preferred, is the Foley catheter. This has a balloon device that allows it to be left securely in place for a significant length of time; others will slip out.

Construction of the Foley Catheter

The Foley catheter has a rounded tip, one or two 'eyes' (holes through which the urine enters the main tube), and a tiny balloon that can be inflated once the catheter is in place. Before insertion the balloon is evident as just a slightly raised area near the tip of the catheter.

The 'outside' end has two branches. One is the main tube, connected directly to the eyes, through which urine flows. The other, which has a small valve on the end, runs inside the main tube and is connected to the inflatable balloon at the tip.

The valve is important: there are three types. One is operated by a hypodermic syringe without a needle. The other type is essentially a plug of soft rubber and requires a hypodermic syringe and a large-gauge needle (a gauge 18 would be fine). A third type has a bulb already filled with sterile water for inflating the balloon, and a clamp to enable the water to flow.

Sterility

Only factory-sterilized catheters should be used. They are packed in sterile, sealed paper/plastic peel-open sleeves. Avoid the temptation to try to sterilize a used catheter. Sterility is essential! New factory-sterilized catheters cost about GBP2.50 (US$4) through medical supply sources, and although non-sterile catheters are also sold, you probably do not have the equipment to sterilize them properly and maintain sterility until use. Some states require a prescription for catheter purchase.

Sizes

Most catheters are the same length -- about 430mm (16"). But there are two size variables: the diameter of the catheter and the size of the balloon. In buying a Foley catheter, you must describe it by both of these dimensions.

Like some other medical items, catheters are sized in the French system. One French unit (Fr) is 0.33mm (0.012"). Thus, an instrument which is 20Fr is 20 x 0.3 = 6mm (0.24") in diameter.

How big a catheter do you want? Most adult males can easily handle a 14Fr, and 16Fr or 18Fr is very common. If the opening of your penis is fairly small, opt for a 14Fr; if it's average, try a 16Fr; if it's a bit larger, try an 18Fr. The urethra can also be enlarged over time by the use of sounds

The balloon of a Foley cath is sized in ml (cc). Typical sizes are 5, 10, and 30ml. I recommend 30ml for reasons which will be made clear below.

So if you are an average sort of guy, you might want a 16Fr/30ml Foley catheter, sterile.

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Other Equipment for Catheterization

As well as the catheter, you will need:

• A sterile hypodermic syringe (luer tip is good), of about 10-12ml capacity.
• A sterile hypodermic needle, around 18 gauge, 25 or 40mm (1" or 1.5") long, if required for valve.
• If you intend to take total control of the bladder, a sterile catheter syringe. This is essentially a very large hypodermic syringe (60ml or more) with a large plastic tip which fits into the outflow tube of the catheter. This must be sterile, sealed in a factory-sterilized package. Otherwise you will need a spigot or clamp to prevent the bladder emptying unwontedly.
• Latex gloves
• Sterile lubricant. Some brands are stabilized with a preservative which can burn slightly when it is in contact with sensitive tissues. KY and H&R brands seem to be the best since they are minimally irritating. Do not use lubricant which contains nonoxynol-9: it is quite irritating to the urethral tissues.
• A sterile --or at least clean -- towel
• Washcloth, soap, and water.

All the specialist items should be available via medical suppliers. See the Resources section of the Play Piercing fact sheet.

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Catheterization Procedure

Inserting the Catheter

Before beginning, fill the hypodermic syringe with sterile water. Wash your hands carefully with soap and water.

Place the bottom on his back in a comfortable position, legs slightly spread. Wash his penis with soap and warm water, carefully, and rinse with plain water, to reduce the surface bacterial count. Anti-bacterial soap may be efficacious. Ideally this would be a sterile procedure, but even in hospitals it cannot be done with full sterility. Some people advocate washing the penis with Betadine, but I do not believe this helps a lot, and it is both a mess and highly staining. A wipe with a Betadine swab is slightly less so.

Put on the latex gloves. Be careful what you touch after this point. Unfold the sterile towel and put it on his belly. Put the unopened catheter on the towel.

Open only the valve-end of the catheter package. Attach the sterile catheter syringe to the large opening. Determine whether the valve requires the needle or not. If so, fit the needle to the 12ml syringe now but do not attach it to the catheter.

Put a small blob of lubricant right on the tip of the penis, at the urethral opening. Carefully remove the catheter from its package, setting the syringe end on the towel. Generously lubricate only the first 75mm (3") of the catheter and insert it gently into the penis. Continue to insert slowly, twisting the cath slightly to be sure its passage is fully lubricated. As you insert more of the cath, lubricate it in 75mm sections. (It is too slippery to handle if you lubricate it all at once.)

Depending on the length of the person's penis, you will probably be able to insert about 25cm (10") of the cath. At some point you will feel slight resistance, and the bottom will report feeling a 'pinch; in a place he cannot describe. You have reached the bladder sphincter muscle, which keeps the bladder closed. Ask the bottom to relax and try to piss a bit -- the catheter should slip into the bladder. When you have inserted about 35-38cm (13"-14") of the catheter, stop. If the bottom has a short penis, stop sooner.

We must now check to be sure the catheter is properly placed in the bladder. We do this by gently trying to withdraw some urine into the catheter syringe. If you do have urine flow, you are in the bladder. If not, you need to insert the catheter farther. Do not go on to the next step until there is evidence of urine in the catheter syringe. The bottom should feel no real pain.

If you do not use a catheter syringe, the point where the bladder is reached is obvious, since there is a gush of urine from the catheter. You should clamp the end of the cath or block it with a spigot, then push a further 75cm (3") or so into the bladder to be on the safe side.

When the cath is in the bladder, attach the hypodermic syringe to the valve and slowly inflate the balloon with water by pressing the plunger of the syringe. It should not be more than the rated capacity of the balloon. I usually use a 30ml balloon and inflate it to 12-15ml, or about half its stated capacity. If the balloon breaks, you could have a problem. If the bottom feels any pain at this point, stop. You probably do not have the balloon in the bladder. After the balloon is inflated, note how much water you have put in, then remove the hypodermic syringe from the valve; the balloon will stay inflated. Keep the catheter syringe in place.

Alternatively if you are using a ready-filled catheter release the clamp that holds the water out of the balloon.

If all has gone well, the balloon is in the bladder. Slowly pull out on the catheter; you will feel resistance, at which point you should stop. The balloon is now at the 'neck' of the bladder, and everything is under control.

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While the Catheter is in

You can now withdraw some urine with the catheter syringe, or you can return the urine to his bladder by the same mechanism. If you remove the catheter syringe from the cath, your bottom will piss until he is empty. Even after he is empty, he will have the sensation that he is pissing. Do not disconnect the catheter syringe and then try to reconnect it and refill him. You will get air in the bladder, and you don't want to do that. You may clamp off the catheter to prevent leakage or to prevent him from pissing when he thinks he needs to. (He will probably have some confused feelings.) I did one scene in which the bottom was blindfolded, and reacted very eagerly when some of his own piss was dripped on his lips from the syringe.

Some people also like to play elaborate piss recycling games by connecting a catheter to a leg-bag (as supplied for incontinent patients), and the outlet of the bag into a drinking tube or gag.

Be gentle with the penis once the cath is in place, and avoid disturbing it too much. Resist any urge to masturbate: this will irritate the urethra and if done vigorously it could injure the bladder or sphincter muscles or nerves.

A Foley cath may be kept in place for awhile, but certainly not with the tube clamped off; you don't want to keep it shut off for so long that urine backs up toward the kidneys. If he really needs to piss, unclamp the tube and let him. Although caths are often kept in place for days in a hospital, I recommend that you do not leave it in place for longer than one to two hours while you play.

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Removing the Catheter

First, deflate the balloon. Re-attach the hypodermic syringe as you did before, and the pressure from the balloon may cause the syringe to refill. Exert a bit of suction with the syringe: be sure you have taken out as much water as you put in; the balloon must be deflated.

Now slowly withdraw the catheter. The bottom may feel slight discomfort, as the balloon has been slightly deformed and it may not be as perfectly smooth as it was before insertion. Wash off any excess lubricant which may emerge from the tip of the penis.

The first two or three times the bottom urinates, he may feel a slight burning sensation. This is normal and is caused by irritation of the urethra; it should go away within 12-24 hours. Urge the bottom to drink a lot of fluids so that he pisses a lot: this will give him the chance to flush out any germs before they multiply.

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Health and Safety Problems

Incorrect Insertion

It is very important to put the catheter in carefully since there is always a chance it can go astray in the urethra and cause real damage. Go slowly and with great care. Though the bottom will feel strange and uncomfortable, particularly if this is a new experience, there should be no real pain. If there is, something is going wrong. It is also a good idea to make sure the bottom hasn't pissed for half an hour or so before the insertion, so there will be some urine in the bladder to help confirm the cath is in place. When in doubt, withdraw the catheter (as carefully as you put it in) and try again another day with a fresh cath. Do not attempt to re-use a cath once withdrawn.

Valve or Balloon Failure

There is a small possibility that the valve will malfunction and you won't be able to deflate the balloon. If this happens, don't panic. Simply cut off the valve with scissors; the water will gush out. Now try to attach the syringe to suck out more. The rubber-plug valves (used with a needle) are less prone to failure than the force-fit valves which do not use a needle.

There is a smaller possibility that the balloon will break inside the bottom. By under inflating it, you reduce this risk even further. And by using sterile water you ensure that anything that might be introduced into the bladder this way is harmless. Withdraw the catheter very carefully and inspect the balloon to be sure there are no missing pieces left inside (highly unlikely). Then let the bottom piss to rid himself of the water from the balloon.

Infection

Bacterial infection in the urethra or bladder is the most common danger of catheterization. The risk of this can never be eliminated totally -- even in hospitals, where caths are inserted in the best of conditions, infections still occasionally occur. The risk can be minimized, however, by following the procedures carefully, using only sterile catheters, and encouraging copious pissing after removal.

If infection does occur, it can be unpleasant, but is rarely a problem if medical help is sought and normally responds well to antibiotics. The symptoms, normally developing within a couple of days of catheterization, include discomfort in the bladder, a constant urge to piss, cloudy urine and maybe feverishness or a feeling of being under the weather. Visit a doctor or a genito-urinary/STD clinic, swallow your embarrassment and tell them what the most likely cause is. Don't put off going: infections can cause serious problems if allowed to take hold. Make sure you're fully recovered before indulging in catheter play again, and indeed any other sort of piss play, especially involving drinking it.

Viral infection involving blood-borne viruses like HIV and Hepatitis is highly unlikely in this sort of play. Urine is normally sterile and will not contain these viruses. However, any game involving exchange of urine via catheters is probably ill-advised, since blood traces sometimes get into urine, and the likelihood of this is increased because of possible minor abrasions and injuries during the insertion.

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This article was first circulated on the Internet in 1996 under the title 'About Catheters'. This version has been revised and expanded slightly by Dirk. © Copyright Tom A. Gordon 1996, 1997. All rights reserved.