Genital self‑mutilation: A challenging pathology (Review)

Lupu,Sorin; Bratu,Ovidiu Gabriel; Tit,Delia Mirela; Bungau,Simona; Maghiar,Octavian; Maghiar,Teodor Andrei; Scarneciu,Camelia C.; Scarneciu,Ioan

doi:10.3892/etm.2021.10564

Genital self‑mutilation: A challenging pathology (Review)

Authors:
- Sorin Lupu
- Ovidiu Gabriel Bratu
- Delia Mirela Tit
- Simona Bungau
- Octavian Maghiar
- Teodor Andrei Maghiar
- Camelia C. Scarneciu
- Ioan Scarneciu
View Affiliations

Affiliations: Clinic of Urology, Brasov Emergency Clinical County Hospital, Brasov 500326, Romania, Clinical Department 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania, Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 3700 Oradea, Romania, Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 3700 Oradea, Romania, Department of Fundamental, Prophylactic and Clinical Disciplines, Faculty of Medicine, ‘Transilvania’ University of Brasov, 500019 Brasov, Romania, Department of Medical and Surgical Specialities, Faculty of Medicine, ‘Transilvania’ University of Brasov, 500019 Brasov, Romania
Published online on: August 5, 2021 https://doi.org/10.3892/etm.2021.10564
Article Number: 1130

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Genital self‑mutilation is a pathology that leads to numerous and important discussions, rarely presented in the medical literature. There have been many attempts to explain the reasons behind these medical phenomena, but single cases have been generally reported, making it extremely difficult to draw valid conclusions. It is acknowledged that there are psychotic and non‑psychotic causes, from psychiatric problems and sexual identity disorders to cultural or religious reasons, alcohol or recreational drug consumption, unconventional types of sexual satisfaction or self‑satisfaction. Recent theories consider self‑mutilation as a phenomenon of reducing distress or tension, as an expression of feelings of anger or sorrow. It is believed that 55‑85% of those who have resorted to self‑mutilation have at least once in their life tried to commit suicide. There is evidence that early discovery and intervention as well as proper treatment in regards to psychosis can significantly reduce the number of self‑mutilation episodes, with a protective role of these individuals. Cases of genital self‑mutilation may be considered real medical emergencies, sometimes extremely challenging and accompanied by severe complications. Injury of the genital area is usually accompanied by numerous early or long‑term complications due to the marked vascular area and to the microbial flora present in this part of the body. The degree of mutilation is an unforeseen aspect that the medical staff may have to encounter during the intervention, sometimes testing their imagination and surgical skills when dealing with such a case. Understanding the causes of these self‑aggressive behaviors, which may be life‑threatening, is critical and multidisciplinary mobilization is needed after treatment of the acute phases. The outcome of these patients depends on integrated collaborative work. These cases represent a serious reason for frustration for the physicians involved in solving them, and knowledge of these issues is valuable to urologists, psychiatrists and other health professionals.

View Figures

View References

1	Baguelin-Pinaud A, Seguy C and Thibaut F: Self-mutilating behaviour: A study on 30 inpatients. Encephale. 35:538–543. 2009.PubMed/NCBI View Article : Google Scholar : (In French).
2	Shoib S, Mushtaq R, Arif T and Hijaz SW: Self-mutilation of genitalia masquerading as suicide: A rare case report. J Psychiatry. 17(115)2014.
3	Gilman SL: From psychiatric symptom to diagnostic category: Self-harm from the Victorians to DSM-5. Hist Psychiatry. 24:148–165. 2013.PubMed/NCBI View Article : Google Scholar
4	Emerson LE: The case of miss A: A preliminary report of a psychoanalytic study and treatment of a case of self-mutilation. Psychoanal Rev. 1:41–54. 1913.
5	Large M, Babidge N, Andrews D, Storey P and Nielssen O: Major self-mutilation in the first episode of psychosis. Schizophr Bull. 35:1012–1021. 2009.PubMed/NCBI View Article : Google Scholar
6	Feldman MD: The challenge of self-mutilation: A review. Compr Psychiatry. 29:252–269. 1988.PubMed/NCBI View Article : Google Scholar
7	Yadukul S, Udaya Shankar BS and Shivakumar BC: A case of genital self-mutilation committed before suicide. Egypt J Forensic Sci. 5:70–72. 2015.
8	Nakaya M: On background factors of male genital self-mutilation. Psychopathology. 29:242–248. 1996.PubMed/NCBI View Article : Google Scholar
9	Greilsheimer H and Groves JE: Male genital self-mutilation. Arch Gen Psychiatry. 36:441–446. 1979.PubMed/NCBI View Article : Google Scholar
10	Eke N: Genital self-mutilation: There is no method in this madness. BJU Int. 85:295–298. 2000.PubMed/NCBI View Article : Google Scholar
11	Rao KN, Sudarshan CY and Begum S: Self-injurious behavior: A clinical appraisal. Indian J Psychiatry. 50:288–297. 2008.PubMed/NCBI View Article : Google Scholar
12	Kharbach Y, Amiroune D, Ahsaini M, Bout A, Riyach O, Stuurman-Wieringa RE, Mellas S, Tazi MF, Khallouk A, El Fassi MJ, et al: Penile self-mutilation preceded by bizarre delusions: Two case reports. J Med Case Rep. 8(246)2014.PubMed/NCBI View Article : Google Scholar
13	Stroch D: Self-castration. JAMA. 36(270)1901.
14	Evins SC, Whittle T and Rous SN: Self-emasculation: Review of the literature, report of a case and outline of the objectives of management. J Urol. 118:775–776. 1977.PubMed/NCBI View Article : Google Scholar
15	Mago V: Male genital self-mutilation. Indian J Psychiatry. 53:168–169. 2011.PubMed/NCBI View Article : Google Scholar
16	Fox C and Hawton K: Deliberate Self-harm in Adolescence. London, Jessica Kingsley Publishers, 2004.
17	Blacker KH and Wong N: Four cases of autocastration. Arch Gen Psychiatry. 8:169–176. 1963.PubMed/NCBI View Article : Google Scholar
18	Mahadevappa N, Kochhar G, Vilvapathy KS, Dharwadkar S and Kumar S: Self-inflicted foreign bodies in lower genitourinary tract in males: Our experience and review of literature. Urol Ann. 8:338–342. 2016.PubMed/NCBI View Article : Google Scholar
19	Aboseif S, Gomez R and McAninch JW: Genital self-mutilation. J Urol. 150:1143–1146. 1993.PubMed/NCBI View Article : Google Scholar
20	Becker H and Hartmann U: Genital self-injury behavior-phenomenologic and differential diagnosis considerations from the psychiatric viewpoint. Fortschr Neurol Psychiatr. 65:71–78. 1997.PubMed/NCBI View Article : Google Scholar : (In German).
21	Joyce PR, Light KJ, Rowe SL, Cloninger CR and Kennedy MA: Self-mutilation and suicide attempts: Relationships to bipolar disorder, borderline personality disorder, temperament and character. Aust N Z J Psychiatry. 44:250–257. 2014.PubMed/NCBI View Article : Google Scholar
22	Gardner DL and Cowdry RW: Suicidal and parasuicidal behavior in borderline personality disorder. Psychiatr Clin North Am. 8:389–403. 1985.PubMed/NCBI
23	Rao KN, Bharathi G and Chate S: Genital self-mutilation in depression: A case report. Indian J Psychiatry. 44:297–300. 2002.PubMed/NCBI
24	Large M, Andrews D, Babidge N, Hume F and Nielssen O: Self-inflicted eye injuries in first-episode and previously treated psychosis. Aust N Z J Psychiatry. 42:183–191. 2008.PubMed/NCBI View Article : Google Scholar
25	Simpson MA: Self-mutilation. Self-injurious behavior: A clinical appraisal. Br J Hosp Med. 16:430–438. 1976.
26	Greydanus DE and Shek D: Deliberate self-harm and suicide in adolescents. Keio J Med. 58:144–151. 2009.PubMed/NCBI View Article : Google Scholar
27	Ahsaini M, Tazi F, Khalouk A, Lahlaidi K, Bouazzaoui A, Stuurman-Wieringa RE, Elfassi MJ and Farih MH: Bilateral testicular self-castration due to cannabis abuse: A case report. J Med Case Rep. 5(404)2011.PubMed/NCBI View Article : Google Scholar
28	Schweitzer I: Genital self-amputation and the Klingsor syndrome. Aust N Z J Psychiatry. 24:566–569. 1990.PubMed/NCBI View Article : Google Scholar
29	Israel JA and Lee K: Amphetamine usage and genital self-mutilation. Addiction. 97:1215–1218. 2002.PubMed/NCBI View Article : Google Scholar
30	Kaba F, Lewis A, Glowa-Kollisch S, Hadler J, Lee D, Alper H, Selling D, MacDonald R, Solimo A, Parsons A and Venters H: Solitary confinement and risk of self-harm among jail inmates. Am J Public Health. 104:442–447. 2014.PubMed/NCBI View Article : Google Scholar
31	Nyhan WL: Lesch-nyhan disease. J Hist Neurosci. 14:1–10. 2005.PubMed/NCBI View Article : Google Scholar
32	Boyle MI, Jespersgaard C, Brøndum-Nielsen K, Bisgaard AM and Tümer Z: Cornelia de Lange syndrome. Clin Genet. 88:1–12. 2015.PubMed/NCBI View Article : Google Scholar
33	Pié J, Gil-Rodríguez MC, Ciero M, López-Viñas E, Ribate MP, Arnedo M, Deardorff MA, Puisac B, Legarreta J, de Karam JC, et al: Mutations and variants in the cohesion factor genes NIPBL, SMC1A, and SMC3 in a cohort of 30 unrelated patients with Cornelia de Lange syndrome. Am J Med Genet A. 152A:924–929. 2010.PubMed/NCBI View Article : Google Scholar
34	Wraight WM, Belcher HJ and Critchley HD: Deliberate self-harm by insertion of foreign bodies into the forearm. J Plast Reconstr Aesthet Surg. 61:700–703. 2008.PubMed/NCBI View Article : Google Scholar
35	Nerli RB, Ravish IR, Amarkhed SS, Manoranjan UD, Prabha V and Koura A: Genital self-mutilation in nonpsychotic heterosexual males: Case report of two cases. Indian J Psychiatry. 50:285–287. 2008.PubMed/NCBI View Article : Google Scholar
36	Money J and De Priest M: Three cases of genital self-surgery and their relationship to transexualism. J Sex Res. 12:283–294. 1976.PubMed/NCBI View Article : Google Scholar
37	Lucerna A: Foreign body insertions: A review. Treating patients who present with foreign body insertions requires a nonjudgmental and open-minded approach. Emerg Med. 49:315–319. 2017.
38	Khan MK, Usmani MA and Hanif SA: A case of self amputation of penis by cannabis induced psychosis. J Forensic Leg Med. 19:355–357. 2012.PubMed/NCBI View Article : Google Scholar
39	Park SC, Park YC and Choi J: A case of Klingsor syndrome in Korea. Psychiatry Clin Neurosci. 65:680–681. 2011.PubMed/NCBI View Article : Google Scholar
40	Poynter BA, Hunter JJ, Coverdale JH and Kempinsky CA: Hard to swallow: A systematic review of deliberate foreign body ingestion. Gen Hosp Psychiatry. 33:518–524. 2011.PubMed/NCBI View Article : Google Scholar
41	Simopoulos EF and Trinidad AC: Two cases of male genital self-mutilation: An examination of liaison dynamics. Psychosomatics. 53:178–180. 2012.PubMed/NCBI View Article : Google Scholar
42	Coccaro EF, Kavoussi RJ and Hauger RL: Serotonin function and antiaggressive response to fluoxetine: A pilot study. Biol Psychiatry. 42:546–552. 1997.PubMed/NCBI View Article : Google Scholar
43	Maria Alexandra Stanescu A, Totan A, Mircescu D, Diaconescu S, Gabriel Bratu O, Fekete L, László Fekete G, Boda D and Cristina Diaconu C: Assessment of suicidal behavior in dermatology (Review). Exp Ther Med. 20:73–77. 2020.PubMed/NCBI View Article : Google Scholar
44	Farcaș C, Botea V, Popescu R, Dinu M, Bratu O, Spînu D and Mischianu D: Penile fracture-clinical case presentation. Romanian J Military Med. 118:45–48. 2015.