Genital self-mutilation in a schizophrenic patient: A case report

Genital self-mutilation is a rare but severe form of self-inflicted injury, most commonly associated with psychiatric disorders, particularly schizophrenia. It poses significant challenges due to the need for urgent urological intervention and psychiatric stabilization. While self-harming behaviors are frequent in psychiatric populations, complete genital mutilation remains an exceptionally rare event [1, 2].

A 38-year-old schizophrenic male, previously well-managed under antipsychotic treatment, presented to the emergency department 1 h after a self-inflicted complete amputation of the penile glans during an acute psychotic episode. On examination, he was hemodynamically stable, with a clean transection, minor hesitation lacerations, and a cold but non-necrotic amputated glans. After emergency psychiatric evaluation and stabilization, he underwent microsurgical reimplantation involving arterial and venous anastomoses (dorsal penile artery and deep dorsal vein), urethral reconstruction, and soft tissue repair.

Despite initial postoperative improvement, progressive ischemia of the glans developed by day 4, leading to necrosis, necessitating revision surgery with debridement. Genital self-mutilation is significantly rarer than outward-directed aggression in schizophrenia. While microsurgical replantation can offer functional recovery, vascular complications remain common. Psychiatric stabilization is critical in preventing recurrence.

Genital self-mutilation in schizophrenic patients represents a complex intersection of psychiatric crisis and urological emergency. Successful management requires a multidisciplinary approach, combining emergency surgery with psychiatric intervention to optimize outcomes and prevent future self-harm. Further research is needed to refine treatment protocols and long-term psychiatric follow-up strategies.