Male genital self-mutilation: a case report

Major self-mutilation in the first episode of psychosis

Major self-mutilation (MSM) is a rare but catastrophic complication of severe mental illness. Most people who inflict MSM have a psychotic disorder, usually a schizophrenia spectrum psychosis. It is not known when in the course of psychotic illness, MSM is most likely to occur. In this study, the proportion of patients in first episode of psychosis (FEP) was assessed using the results of a systematic review of published case reports. Histories of patients who had removed an eye or a testicle, severed their penis, or amputated a portion of a limb and were diagnosed with a schizophrenia spectrum psychosis were included. A psychotic illness was documented in 143 of 189 cases (75.6%) of MSM, of whom 119 of 143 (83.2%) were diagnosed with a schizophrenia spectrum psychosis. The treatment status of a schizophrenia spectrum psychosis could be ascertained in 101 of the case reports, of which 54 were in the FEP (53.5%, 95% confidence interval = 43.7%-63.2%). Patients who inflict MSM in FEP exhibited similar symptoms to those who inflict MSM later in their illness. Acute psychosis, in particular first-episode schizophrenia, appears to be the major cause of MSM. Although MSM is extremely uncommon, earlier treatment of psychotic illness may reduce the incidence of MSM.

Penile self-mutilation as an unusual sign of a separation-related problem in a crossbreed dog

A two-year-old, male, crossbreed dog was presented for evaluation of licking, biting and severe self-mutilation of its penis, which resulted in ulcers and haemorrhagic preputial discharge. History revealed signs of separation anxiety such as active greeting behaviour, excessive vocalisation and intermittent episodes of licking of the penis when the dog was left alone. The owner reported that he had been hospitalised after a car accident, and he had no chance of seeing the dog. During that time, the behaviour progressed to frequent episodes of licking and biting of the penis. Three weeks of treatment with clomipramine in addition to the presence of the dog's brother, who was brought into the dog's living environment, appeared to produce a considerable degree of improvement. The purpose of this report is to contribute to an increased awareness within veterinary practice of unusual signs of separation anxiety such as penile self-mutilation.

[Penile injury caused by a Moulinette. Result of autoerotic self-mutilation]

Autoerotic manipulations of external male genitals resulting in mutilation with different degrees of severity are rare. We report the clinical case of a 12-year-old boy who injured his glans, left corpus cavernosum and corpus spongiosum with opened urethra as a consequence of autoerotic genital self-mutilation. According to our knowledge of the current literature this is the first description of autoerotic genital self-mutilation with a Moulinette. A Moulinette is a kitchen tool with an electric engine and an extremely fast rotary double knife, which is used to reduce food into small pieces, especially vegetables and fruits.

Das männliche Genitale in der gerichtlichen Medizin

Pathomorphological findings for the male genital are an exception among forensic cases. In earlier publications they were usually published as individual cases. A significant percentage are the so-called fertility- and potency medical certificates, which are usually commissioned for doubtful paternity cases. Old forensic writings about genital injuries distinguish--apart from the necessity of a complete dissection--between "deadly as such" and "accidentally deadly" injuries. Another group consists of reports about self-inflicted genital mutilation, e.g. among prison inmates or soldiers of the last world wars to become an invalid. When it was necessary to identify a corpse, e.g. in cases of progressive decomposition, Merkel recommended in 1945 the representation of the so-called "Schnepfenkopf" (snipe head; colliculus seminalis) in the lesser pelvis. In this article a medical and forensic review of forensically relevant findings of the male genital is presented and illustrated with historical cases.

Repetitive male genital self-mutilation: a case report and discussion of possible risk factors

Male genital self-mutilation is an infrequently reported occurrence in the medical literature. The reports describing such cases have focused mostly on surgical repair. The case reports written from a psychiatric point of view have outlined possible risk factors contributing to this behavior. Typically, reports depict cases of a single episode of self-mutilation. To date, we have found twelve cases that have addressed the specific issue of repeated episodes of genital self-mutilation. In this article, we report the case of a 49-year-old man who succeeded in castrating himself after sequential episodes of genital mutilation. We will review previous cases of repetitive male genital self-mutilation and draw comparisons between those and our patient's case to arrive at common risk factors that may alert the clinician to this type of behavior.

Male genital mutilation: 'whodunnit'?

A 26-year-old man was brought to hospital having sustained amputation of his penis, scrotum and testes. Although he claimed that his 'master' did it, the 'master' denied the allegation. The police subsequently retrieved the two testes but the amputated penile shaft was never found. The remaining scrotum and short penile stump were repaired to enable him pass urine. The evidence of the patient was not corroborated. No motive for the amputation was established. The patient refused to appear in court as prosecution witness against the accused, his 'master'. Furthermore, although he has not withdrawn his accusation, he has paid friendly visits to the master subsequently. There is, therefore, the suspicion that the patient was himself responsible for the amputation. This patient will require long-term psychological, endocrinological and urological follow-up.