In 1977, the anthropologist Peter Furst and the archaeologist Michael Coe described and depicted their discovery of the non-medicinal use of enemas on a polychrome Maya jar from the Classic period (250-900/1100 CE) b in a private collection that is now in the Metropolitan Museum of Art in New York (Fig.1): “…. Seven male-female pairs, the women easily distinguished by their robes and long hair, are depicted in two horizontal rows. That one woman is fondling a child suggests a familial setting. The activity being portrayed would have brought blushes to the cheeks of the traditional Maya specialist, for while one man is inserting a syringe into his rectum, this delicate task is being carried out for another male by his consort. One male also has a bulbed enema syringe tucked into his belt. Nine vases, identical in shape to the actual vessel, are painted between the couples, and painted dots at the mouth of each represent a foaming, fermented liquid that is probably balche, the common alcoholic drink among the Maya at the time of the conquest. We must conclude that the people on the vase are taking intoxicating enemas, a practice previously unrecorded for this culture …..” (Furst and Coe 1977:90). The discovery of this jar painting was crucial because it allowed the recognition of previously enigmatic other representations in Classic Maya art as ritual enema scenes and objects (Furst and Coe 1977). The first systematic analysis of this subject by (Hellmuth 1985) was extended to a chapter in my Ph.D. thesis about ritual enemas and snuffs in the Americas (De Smet 1985:55-72) which was subsequently republished as a separate article (De Smet and Hellmuth 1986). The present 4P-review revisits the iconography, epigraphy and ethnopharmacology of Maya enema scenes on the basis of these reviews from 1985/1986, later publications about this subject (Barrera Rubio and Taube 1987) (Stross and Kerr 1990) (Taube 1998) (Stuart 2005b) (Houston, et al. 2006:116-122) (Henderson 2008) (Boot 2009) (Stone and Zender 2011) (Just 2012) (Houston 2018:126-130), and the extensive online Maya vase database set up by Justin Kerr, New York, which contains no less than forty examples of Maya enema representations c . The 4P-review below refers primarily to specific vase and bowl paintings in Kerr’s database by copying his codes that always consist of the letter K followed by the number of the painting in question (e.g., K1890). Paintings that have been depicted in (De Smet 1985) d are referred to by codes that always start with the letters PS followed by the specific Plate number in this book (e.g., PS-3).