Male genital trauma caused by self-mutilation: A first case series report in Indonesia.

INTRODUCTION AND IMPORTANCE: Genital self-mutilation (GSM) is a rare phenomenon with a spectrum ranging from a superficial laceration to complete amputation of the external genitalia. These could result in severe impairment of genitourinary functions. Psychotic disorder adds to the complexity of the patients. Since GSM is underreported, we report the first case series in Indonesia.

CASE PRESENTATION: Four included patients comprised different injuries to the external genitalia, from a superficial laceration to penile amputation. Notably, these patients exhibited psychotic traits. Initial management consisted of bleeding control, debridement, and primary suturing. Depending on the extent of the injury, the repair comprised of spermatic cord ligation, penile reconstruction using a skin flap, defect closure with urethral spatulation, and exploration. We successfully managed all the patients surgically before undergoing psychotherapy to improve the patient's overall well-being and to reduce the risk of similar reoccurrence of GSM behavior.

CLINICAL DISCUSSION: The majority of GSM cases were associated with psychotic disorders. The current reports' injuries include penile laceration, total penile amputation, unilateral castration, and combined injury to the penis and scrotum. Although most GSM is not life-threatening, it may cause emergent, complex, and serious complications such as massive hemorrhage and severe infections. Appropriate investigations with systematic treatment strategies are required, especially in complex cases.

CONCLUSION: The incidence of genital self-mutilation necessitates a prompt evaluation of organ viability and the possibility of preserving tissue for optimal urinary and sexual outcomes. Interdisciplinary collaboration is required as the primary concern for management in cases of genital self-mutilation involving male genitalia and underlying psychological disorders.