Genital self-amputation-its psychological urge

Area of Science:

• Urology
• Psychiatry
• Forensic Medicine

Background:

• Genital self-mutilation (GSM) is a rare and severe manifestation of psychiatric illness.
• Transgender individuals with a history of mental health issues may be at higher risk.
• Prompt recognition and management are crucial for patient outcomes.

Observation:

• A transwoman with a psychiatric history presented with bilateral testicular amputation, followed by partial penile amputation.
• Emergency surgical intervention was required to control hemorrhage and ligate spermatic cords.
• The patient, deemed to have capacity, refused testicular reimplantation.

Findings:

• Successful hemostasis was achieved through bilateral inguinal ligation of the spermatic cords.
• The patient required psychiatric hospitalization under the Mental Health Act following the second incident.
• This case underscores the complex interplay between severe mental illness and GSM.

Implications:

• Effective emergency surgical techniques for GSM-induced hemorrhage are demonstrated.
• Highlights the necessity of thorough psychiatric assessment and management in patients presenting with GSM.
• Emphasizes the importance of considering underlying psychiatric conditions in patients with severe self-harm behaviors.