GENITAL SELF-MUTILATION

We report a series of 14 patients with 19 self-inflicted genital injur ies during a period of 10 years. Of the patients 65% were psychotic an d 35% were not psychotic. Repeated attempts at genital self-mutilation occurred in 31% of the cases, mainly in the psychotic group. A histor y of alcohol and/or drug abuse was present in 55% of the cases. Injuri es varied from simple laceration of penile or scrotal skin to actual a mputation of the penis or testis. The degree of injury did not differ between the psychotic and nonpsychotic patients. Surgical management a nd outcome varied according to the severity of the injury, the delay i n presentation for treatment, and the degree of alteration in the ment al status and behavior. Followup of 9 patients showed good cosmetic re sults with no immediate or delayed complications related to the injury . The functional results in patients with penile replantation were sat isfactory. In 1 patient a urethral stricture developed that was succes sfully managed endoscopically. Erectile function was difficult to asse ss because of the marked diversity of sexual behavior in this group.