Repeated self-mutilation of testicles in the context of methamphetamine use - A case report and brief review of literature.

We report a case of recurrent genital self-mutilation (GSM) after use of methamphetamine. A 29-year-old male with borderline personality and polydrug misuse attempted the GSM twice. Firstly, he self-amputated his left testicle, and one year later he injected printer ink in his right testicle. An open revision of the injured area revealed a puncture wound in the right testicle, with a palpable accumulation of fluid. No ink was found inside the scrotal sac suggesting that the substance was injected directly to the testis. Due to the absence of left testicle, the urologist decided against orchiectomy. Blue colour of serum, urine and sperm was observed for nine days, and then spontaneously disappeared. An ultrasound imaging showed enlargement of the right testis with hypoechogenic fluid/ink collection. Pathomorphological examination of the testicular tissue revealed focal necrosis and diffuse suppurative inflammation of the testicular tunic. Examination of the sperm showed significantly reduced amount of sperm, with majority of dead spermatocytes. Follow-up examination at six months and two years showed absence of spermatocytes. Some attempts of GSM can be repeated. Therefore, specific preventive measures should be undertaken whenever a standard advice and motivational interviewing proved ineffective. Depending on local and general toxicity of an injected xenobiotic, orchiectomy should be considered as a treatment option of GSM. Injection of potentially low toxic ink into the testicle can lead to its permanent damage and infertility.