EN
TÜRKÇE
Poster - 242
Self-castration: when surgeon is not enough
Beata Vincel, Gilvydas Verkauskas
Vilnius University Hospital Santariskiu Klinikos - Childrens Hospital, Vilnius, Lithuania
Introduction
Genital self-mutilation (GSM) is a rare urological emergency ranging from mild forms of superficial cuts to genital region to serious and life-threatening conditions: castration and/or penile amputation. First published case report of self-castration was by Stroch in 1901. Up to date, less than 200 cases are reported in the literature with adolescent description being solitary. True incidence and prevalence of GSM is unknown due to the lack of epidemiological studies. It is likely, that mild cases that do not require urgent medical attention are underreported. Most often GSM is associated with mental disorders and/or substance abuse.
Case presentation
17 year old male was presented to our hospital with scrotal laceration and right testicle exterioration through the wound. At night patient tried to remove testicles by cutting them out. His motive was „to diminish harmful effects of testosterone“. During interview and examination the young man demanded to remove both his testicles. Otherwise youngster threatened to commit suicide. Therefore psychiatric consulting was arranged before surgical treatment and after the successful surgery further treatment was continued in specialized department. At that point neither body integrity dysphoria nor transsexualism was diagnosed. After reaching adulthood the patient was diagnosed with transsexualism. Young man was followed-up by psychiatrists as he continued to demand the removal of his testicles although he did not comply with the prescribed endocrinological treatment. Multidisciplinary team was convened to clarify the diagnosis and provide recommendations for further monitoring and treatment.
Conclusion
GSM treatment is challenging due to associated mental disorders and underlying causes. These patients require multidisciplinary approach not only in terms of surgical specialists, but also other professionals with psychiatrists being fundamental. After executing surgical treatment, it is important to ensure long-term follow-up and psychological therapy for these patients.