A case report of genital self-mutilation in a patient with psychosis

Self-mutilation is one of the most extreme types of self-harm, which is done deliberately to hurt the body, regardless of suicidal intent. In self-mutilation, the most important targets are the eyes, genital tract, and hands. So far, genital self-mutilation (GSM) has been less frequently reported around the world. According to our study, this is the first case of GSM reported in Iran. The most common cause of GSM is psychological disorder, especially psychosis.

The patient was an unmarried 32-year-old man, who was hospitalized in Rasul-Akram Hospital in December 2018 for severe bleeding caused by GSM. He was diagnosed with type I bipolar disorder, which was treated from the late adolescence. Also, a history of drug abuse (amphetamine, opium, cannabis, alcohol) and multiple sexual relationships with different partners was reported. He abused tramadol tablets daily nowadays. His IQ was normal. He had lots of abrasions, scars and lacerations due to suicidal attempts in the past years. Two months before GSM, his auditory hallucinations about genital self-mutilation had started. He committed GSM after having sexual intercourse and was transferred to our hospital by an ambulance with severe hemorrhage, scrotum damage, and presentation of both testes, for which he received appropriate treatments.

It seems that a set of factors, such as patient's history of psychosis following bipolar disorder, substance abuse, mental retardation, multiple sexual relationships, and strong emotional relationship with the mother can contribute to self-injury that may lead to genital self-mutilation. It should be noted that genital self-mutilation cases are less likely to be reported in Iran, considering the cultural and religious background. Therefore, the pathology of this devastating phenomenon should be more thoroughly examined.