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

## TL;DR

A 38-year-old man with schizophrenia self-amputated his penile glans during a psychotic episode and required emergency surgery and psychiatric care.

## Contribution

This case report highlights the rare occurrence of genital self-mutilation in schizophrenia and the challenges of its multidisciplinary management.

## Key findings

- Genital self-mutilation in schizophrenia is rare and requires urgent urological and psychiatric intervention.
- Microsurgical reimplantation failed due to postoperative glans necrosis, necessitating revision surgery.
- Psychiatric stabilization is critical to prevent recurrence of self-harm behaviors.

## Abstract

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.

•Severe genital self-mutilation is rare and typically associated with schizophrenia.•A schizophrenic patient amputated his glans; reimplantation was attempted in emergency.•Postoperative glans necrosis occurred and required secondary surgical management.•Urgent multidisciplinary care is vital; psychiatric follow-up is key to prevent recurrence.

Severe genital self-mutilation is rare and typically associated with schizophrenia.

A schizophrenic patient amputated his glans; reimplantation was attempted in emergency.

Postoperative glans necrosis occurred and required secondary surgical management.

Urgent multidisciplinary care is vital; psychiatric follow-up is key to prevent recurrence.