Extent of mutilation:
(1) limited and superficial - incisions, injections, scarification
(2) partial removal
(3) removal of penis or testicles (incomplete castration)
(4) complete castration with removal of penis, testicles and scrotum
Reasons for genital self-mutilation may include:
(1) psychotic illness, especially if there is sexual guilt (may be first indication of mental illness)
(2) transient psychosis due to drugs, depression or other cause
(3) intoxication with loss of impulse control
(4) depression or suicidal ideation
(5) religious fervor (Schwerkoske et al note 4 references to self-mutilation in the Gospel of Matthew. Matthew 9:43 says to cut anything off that is a source of sin. Matthew 19:12 recommends becoming a eunuch for heaven's sake.)
(6) sexual obsession or perversion
Differential diagnosis:
(1) circumcision as ritualistic religious genital mutilation (either consensual or parental)
(2) circumcision or other resection for medical reasons
(3) piercings and placement of ornament (consensual)
(4) punishment by someone else (nonconsensual and not self-mutilation)
(5) castration as political policy (nonconsensual and not self-mutilation)
(6) accidental
(7) castration preceding gender reassignment from male to female
(8) congenital malformation
