I really want to ask: Why did the "butt injection" that was popular when we were young disappear?

When you think of injections, do you think of "injections in the buttocks" or "injections in the arm"? For older people, the image that comes to mind may be an injection in the buttocks.

Nowadays, buttocks injections seem to be rarely used. So, have buttocks injections really disappeared? This starts with what buttocks injections are.

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What is a butt shot?

What we call buttock injection is actually a form of intramuscular injection, which means injecting the drug into muscle tissue. In addition to intramuscular injection, there are also common intravenous injection, subcutaneous injection, and intradermal injection, which are suitable for different types of scenarios.

1

Intradermal injection

This is the injection method we usually use when doing a "skin test". The doctor will place the needle close to the surface of the skin and inject the medicine. This is because the injection point is very close to the surface of the body, and if the body reacts, it is easier to observe.

2

Subcutaneous injection

The most common method is insulin injection. Large molecular proteins such as insulin are not suitable for oral administration and need to be administered by injection. Subcutaneous injection is simpler than intravenous injection and intramuscular injection, and can be performed without professional medical staff. For insulin that needs long-term injection, this injection method is very suitable.

3

Intravenous injection

Intravenous injection, as the name implies, is to inject the drug directly into the vein. What we call hanging water and dripping belong to intravenous injection. The advantage of this injection method is that the drug is directly injected into the blood, the drug is not easily metabolized by organs such as the liver, and it can be delivered to the whole body as quickly as possible. When the drug needs to take effect quickly, the doctor will choose this method.

4

Intramuscular injection

Like intravenous injection, intramuscular injection can also prevent drugs from being metabolized by the liver. Compared with intravenous injection, intramuscular injection of drugs will take longer to take effect. This injection method is often used when injecting many types of vaccines and drugs that may cause greater vascular irritation.

The buttocks are very thick, so they are naturally one of the "excellent candidate areas" for intramuscular injection. In addition, the outer thigh (rectus femoris) and the deltoid muscle on the arm are also "candidate areas" for intramuscular injection.

However, many people may still have some "childhood trauma" about buttock injections. It seems that buttock injections are more painful than "arm injections". Why is this?

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Why do butt shots hurt so much?

First of all, this may be related to our lower tolerance for pain when we were young and our psychological fear of injections. But in addition to this, there are indeed several objective factors that make buttock injections particularly painful.

1

Blunt needle

For people in their 50s and 60s, the pain may come from the repeatedly used “blunt needles”.

When medical conditions were not well developed, many hospitals and clinics used sterilized and reusable needles instead of disposable needles. For example, the "needle sterilizer" below is used to sterilize needles.

Needle sterilizer, source: Product screenshot

Although it is reasonable to grind the needle tip flat after repeated use for a period of time, it is inevitable that there will be some "small burrs" on the needle after repeated use. You don't need to experience it yourself, just imagine how painful it would be if such a needle pierced into the flesh.

2

"Deeply pierced"

After the improvement of medical conditions, although the problem of "blunt needles" has been solved, in order to avoid the thick fat layer on the buttocks, buttocks needles are often inserted very deep, often needing to penetrate 2 to 3 centimeters into the flesh. The deep wound caused by the needle will also increase the pain.

3

"Suction"

In the past, when giving butt shots, medical staff might follow a procedure that involves aspirating before injecting to ensure that the needle does not pierce a blood vessel (otherwise it would become an intravenous injection).

A 2015 review pointed out that compared with direct injection, the action of suctioning can cause more pain. Currently, the US Centers for Disease Control and Prevention, the Public Health Agency of Canada and other agencies also believe that there are no large blood vessels in the area of ​​​​intramuscular injection, and there is no need to suction during injection. But in any case, suction may also be one of the culprits that we felt that buttock injections were "painful" when we were young.

Are butt shots gone?

So why are buttock injections becoming less and less common nowadays? Have buttock injections really disappeared?

Let me give you the answer first: In fact, butt shots have not disappeared, but the scenarios where they are needed have become fewer.

The most important reason is that with the development of modern medicine, there are more drugs that can be taken orally, such as various penicillin derivatives, than before. Since the problem can be solved by taking medicine, who would be willing to get an injection?

Moreover, for adults, most vaccines that do not require a particularly large dosage can also be administered through an arm needle (deltoid muscle injection), so there is no need to take off pants for the injection.

In addition, a 2006 study also showed that the effect of buttock injections may not be as good as imagined. As the obesity problem becomes more and more serious, the thickness of people's subcutaneous fat layer increases, which brings trouble to buttock injections. The study counted the effects of buttock injections on 50 patients and found that only 16 people received real intramuscular injections, and the other 34 people actually received subcutaneous injections (injected into the fat layer), which may make vaccines that require intramuscular injections ineffective.

In addition, improper buttock injections may cause sciatic nerve damage.
For all these reasons, buttock injections are becoming less and less common. However, for some intramuscular injections with large dosages, buttock injections may still be necessary to make them effective.

References

[1] Usach, I., Martinez, R., Festini, T., & Peris, JE (2019). Subcutaneous Injection of Drugs: Literature Review of Factors Influencing Pain Sensation at the Injection Site. Advances in therapy, 36(11), 2986–2996. https://doi.org/10.1007/s12325-019-01101-6

[2] Wright JC, Burgess DJ (29 January 2012). Long acting injections and implants. Springer. p. 114. ISBN 978-1-4614-0554-2.

[3] Sisson H. Aspirating during the intramuscular injection procedure: a systematic literature review. J Clin Nurs. 2015 Sep;24(17-18):2368-75. doi: 10.1111/jocn.12824. Epub 2015 Apr 14. PMID: 25871949.

[4] Chan VO, Colville J, Persaud T, et al. Intramuscular injections into the buttocks: are they truly intramuscular?[J]. European journal of radiology, 2006, 58(3): 480-484.

[5] Zuckerman JN (2000). The importance of injecting vaccines into muscle. Different patients need different needle sizes. BMJ (Clinical research ed.), 321(7271), 1237–1238. https://doi.org/10.1136/bmj.321.7271.1237

Planning and production

Author: Science Scraps Popular Science Creation Team

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association

Planning丨Lin Lin

Editor: Zhong Yanping

Proofread by Xu Lailinlin