DEAR ANDREA: Your answer to "Blue Bottle" (concerned about the dangers of using an open-ended bottle as a sex toy) missed an important caveat. Forcing air into the vagina can cause serious consequences – not from uterine prolapse but from venous air embolism (tinyurl.com/ypjy6). A dozen or more fatalities are known (most in pregnant women), plus at least one case involving miscarriage and permanent brain damage. Many more, no doubt, have gone unreported.

I refer you to venous air embolism following orogenital sex during pregnancy (tinyurl.com/2pywo), air embolism death of a pregnant woman secondary to orogenital sex (tinyurl.com/2snbk), and fatal air embolism during female autoerotic practice (tinyurl.com/2uhhz).

Love, Childbirth Educator

Dear Ed: The air embolism thing is a well-known sex-ed bugbear. I did consider mentioning it, but – the extraordinary unlikeliness issue aside – it just didn't seem relevant at the time. It apparently requires a separate, nothing-to-do-with-Coke-bottle-dildos column of its own, though, so here you go.

I do need to point out that two of your cites report the same case of "insufflation" during oral sex, the eMedicine article on air embolism in general describes assorted invasive surgical procedures gone wrong, and the last involves ... a carrot.

Seriously. "We report a case of air embolism in a 40-year-old non-pregnant woman subsequent to vaginal insertion of a foreign body (carrot) for an autoerotic purpose. The mechanism is roughly similar to syringing, the foreign body acting like a piston to displace a sufficient amount of air."

This case, tragic as it is, bears an unfortunate moral: avoid inserted foreign bodies acting like a piston – in other words, no fucking. As implementing this rule would fatally damage relations between the sexes and cause the eventual extinction of the human race, not to mention putting me out of business, I just can't get behind it, sorry.

There's nothing to be done with the sad story of the lady and the carrot, I'm afraid. It will have to be filed with sudden deaths from drinking a glass of water, eating an apple, or taking a walk. These things might be fatal one out of however many million times, but most people – those crazy risk-takers! – are going to do them anyway. Granted, it's easier to avoid internal pistoning action than, say, walking, but even if it's true that many such fatalities go unreported, a campaign against pumping things in and out of vaginas ... well, "quixotic" is a nicer way to put it than "hopeless and crazy."

Let's move on to "vaginal insufflation." I've heard of women dying from having air pushed forcefully into their vagina. Luckily, very few women enjoy having air pushed forcefully into their vagina, so the point was somewhat moot before we got there. Insufflation does happen occasionally. The one bona fide case I've ever encountered semipersonally was witnessed by a physician acquaintance. His young patient showed up at the E.R. with abdominal bloating and terrible sharp, stabbing pains. They were about to admit her when she suddenly ... deflated. Didn't die. Just wanted to.

No question, if you're pregnant (or postpartum, or like Carrot Lady, have an IUD), you should avoid having air blown forcefully into your vagina. Attempting a home abortion with a syringe is likewise not recommended. For the nonpregnant, I can't see any reason for anyone to play with a compressor hose, but I will go so far as to agree that nobody should do so. We're on the same page there.

This is all very interesting, but I'm not sure what any of it has to do with the original letter, as none of the cases cited implicated open-ended sex toys. We can save the physics discussion – is an open bottle more or less likely to pump air into the uterus? – for later. Meanwhile, if I hear from Blue Bottle again, I'll add carrots to the list of potentially deadly objects she should remove from her vicinity.

Love,
Andrea

Dear Andrea: My wife heard about a position called "helicopter," but we have no idea what it is. Could you enlighten us?

Love,
Whirly Bird

Dear Bird: Isn't that where you insert a remote-controlled toy helicopter into your wife and turn it on? Don't do that. I've heard it can force air into the uterus and cause an embolism.

No, I wasn't serious. The truth is I never know anything about the Parisian Poodle or the Enraged Toucan or whatever; they all sound like particularly ill-advised yoga positions to me. According to some poorly translated Japanese porn site, though, it's woman facedown and ass-up, man in precarious push-up position with legs over her back, facing away from each other. Go nuts.

Love,
Andrea

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