Understanding self-inflicted penile strangulation: a case series analysis of clinical management and psychological...

Injuries to the penis resulting from self-inflicted strangulation with various objects are uncommon, yet these injuries are more frequently observed in young adults. Medical literature has identified items such as hair, thread, rubber bands, metallic rings, and vacuum erection devices as tools used for this purpose. These constrictive items impede venous return from the penis, potentially leading to severe complications such as ischemia or necrosis. This case series aims to analyse the clinical presentation, management strategies, and psychological dimensions of self-inflicted penile strangulation through a case series.

We conducted a retrospective analysis of three cases of penile strangulation treated at All India Institute of Medical Sciences, Rishikesh between 2022 and 2023. Cases were classified using a modified Bhat et al. grading system. Management techniques, complications, and psychological assessments were documented with a follow-up of 2 years. Individual consent was obtained from the patients for this case series. This article has been prepared according to the PROCESS guidelines. The cases represented a spectrum of clinical severity (Grades I-IV) with diverse constricting devices (metallic ring, plumbing fixtures, hair fibres) and presentation times (6 h to several days). Device-specific removal techniques were employed with successful outcomes. Psychiatric evaluation revealed distinct patterns: sexual experimentation in younger patients (35 and 32 years old) and major depressive disorder with paraphilic tendencies resulting in chronic self-harm (53-year-old), which eventually required partial penectomy.

This study underscores the critical need for healthcare providers to recognize and understand the complexities surrounding self-inflicted penile strangulation injuries. By increasing awareness, providers can better address the psychological dimensions and surgical management strategies associated with these cases. Furthermore, involving the family in the patient's care is essential; counselling and education can play a pivotal role in preventing future recurrences of major depressive disorder.