Ok, so this one I have been waiting to post. It is just so foul. Be warned. A woman came in to the dept with her significant other with a complaint of frequent urinary tract infections and now urinary incontinence. She was only in her mid 30′s with two kids. Her incontinence was severe – she basically just leaked urine as soon as her kidneys made it. During exam, it was noted that her genitalia was very abnormal appearing. Just below her clitoris, there was a gaping hole – too anterior to be the vagina but too large to be…..wait, could it be??!?!?! Yes, it was her urethra gaping open about 1-2 inches in diameter! Urine would just drip out. Now, here is the worst part. The way she got to this point. She finally revealed that her man had developed a bizarre fetish. He requested (or maybe it was forced, who knows?) that she insert progressively larger dilators into her urethra so he could have sex with her that way. Finally he had been successful and over the past several weeks, he would routinely have urethral intercourse with her, causing infections and of course, complete incontinence. Unfortunately this situation is not readily remedied. There is no good surgery for it and the only solution is to place a suprapubic catheter coming out of the skin directly from the bladder – forever! I mean, I think “to each his own” but this fits the definition of a sick f*** if ever there was one. What a SHPOS (see here for definition ). Then again, this woman needed some psychiatric help too to have let him do this.