Genital self-mutilation in psychiatric patients: A case report

Genital self-mutilation presents significant surgical challenges, particularly when complicated by psychiatric disorders. This case highlights the critical role of surgical intervention in the management of self-inflicted severe penile injuries and underscores the need to integrate surgical and psychiatric care to optimise results. A 43-year-old man, with progressive psychiatric issues, self-inflicted penile amputation. He arrived late in the emergency room with a poorly preserved amputated penis, complicating potential reimplantation. The surgeons extensively debrided and created a urethrostomy on the anterior scrotum wall, preparing for future phalloplasty. This planning ensured tissue viability and minimised postoperative complications. Early psychiatric evaluations revealed hebephrenic schizophrenia. Unfortunately, after psychiatric stabilisation, he was lost to follow-up and was not present for phalloplasty. Severe penile lesions require restoration of appearance, preservation of functions, and minimisation of complications. The surgical approach depends on the hospital capabilities, expertise, and patient condition, our patient's case required an anterior urethral anastomosis of the scrotum wall in consideration of phalloplasty. Pairing surgical intervention with immediate psychiatric care is crucial for optimal outcomes. However, the loss of follow-up postpsychiatric discharge in our patient highlights the need for improved monitoring to ensure adherence to treatment. This case highlights the interaction between severe genital trauma, psychiatric instability, and surgical management in patients who engage in self-genital mutilation. It underscores the importance of a multidisciplinary approach that involves both surgical and psychiatric. Enhanced strategies for psychiatric involvement and monitoring are crucial, especially for people scheduled for complex reconstructive surgeries such as phalloplasty. •Case of penile amputation after self-mutilation•Customised surgical decisions for complex amputation cases•Preparatory management for future phallic reconstruction•Integrated psychiatric support to optimise recovery•Highlights the importance of psychiatric care in surgical cases