Byline: Rajendra. Nerli, Indupur. Ravish, Shrishailesh. Amarkhed, Ujjaini. Manoranjan, Vikram. Prabha, Ashish. Koura
Genital self-mutilation is a rare event that is commonly associated with psychotic disorders. However such injuries have also been reported from nonpsychotic patients as a result either from bizarre autoerotic acts, attempts at crude sex change operation by transsexuals or secondary to complex religious beliefs and delusions regarding sexual guilt. We report two cases of genital self-mutilation in nonpsychotic married heterosexual males as a result of conflict and frustration.
Genital self-mutilation is a severe form of self-injurious behavior. Self-mutilation is described as the "deliberate destruction or alteration of body tissue without conscious suicidal intent." It has been performed by individuals throughout history. Genital self-mutilation has been a religious practice since ancient Roman times. Roman priests regarded this custom as "a supreme sacrifice of sexual life in favor of the emotion to the highest known good." Majority of cases of genital self-mutilation reported in the literature have been in patients with psychosis. Greilsheimer and Groves[sup]  in a group of 52 cases of genital self-mutilation, found 87% to be psychotic and 13% to be nonpsychotic. The psychotic cases ranged from those with functional psychosis to those with brain damage. The nonpsychotic cases included character disorders, transvestism, and complex religious or cultural beliefs. Aboseif et al .[sup]  in a series of 14 patients of self-inflicted genital injuries, found 65% of cases to be psychotic and 35% to be nonpsychotic. It is suggested that genital self-mutilation may be a pathway out of diverse psychological disorders and in nonpsychotic cases it could be an expression of psychotic solution to a conflict and may be influenced by cultural factors.
We report two cases of genital self-mutilation, wherein the patients sought a psychotic solution to a conflict /stress and was influenced by social, cultural, and religious factors.
A 52 year old policeman was admitted with history of genital self-mutilation. This patient was married, had two grown-up children, and had no history of psychosis previously or treatment for the same. The policeman was arrested for some illegal departmental activity and was imprisoned. He was being questioned regarding theft in police armory and was under severe stress. The patient also gave history of severe physical and mental torture. He took this extreme step of self-mutilation as a protest to the stress he was undergoing. He was brought to the hospital in a serious condition. He had mutilated his genitals with a blade. Both the testes and the shaft of penis were severed. The penis was collected from the toilet and brought to the hospital a few hours later. Microvascular reimplantation of the penis was done by the plastic surgeons. The patient was counseled. The penis became ischemic and needed amputation with creation of perineal urethrostomy. The patient was followed up and in this period he needed no psychiatric treatment. The patient died after 34 months due to myocardial infarction.
A 38 year old married construction contractor was admitted with shock due to self-mutilation of genitals. The patient had used a kitchen knife to severe his genitals. As the patient was admitted nearly ten hours after the injury, no attempt for microsurgical reimplantation was attempted. The penile stump was refashioned and the scrotum sutured [Figure 1A] and [Figure 1B]. The patient was counseled. This patient gave no history of previous psychosis or treatment for the same. This patient was under severe mental stress due to harassment from police and other authorities following the death of a laborer during construction activities. The patient has been under follow-up since 14 months and now desires reconstruction of phallus. …