Presentation and resolution of gender dysphoria as a positive symptom in a young schizophrenic man who presented with self-emasculation: Frontiers of bioethics, psychiatry, and microsurgical genital reconstruction

Abstract

Gender dysphoria can present as a positive symptom of schizophrenia. Completion of gender affirmation surgeries should not occur as a result of male genital self-mutilation via a deferral of emergent surgical reconstruction. Instead, gender affirmation should be considered after a full workup and assessment for resolution of any acute psychosis.

Keywords: gender dysphoria; penis; schizophrenia; self‐amputation; self‐castration.

Figure 1

Amputated penis, testicles, and scrotum. Distal penile stump was approximately 5 cm in length. Bilateral testes were amputated near the epididymides with approximately 3‐4 mm of spermatic cord stump remaining on the testicular side

Figure 2

Medical leech therapy. A, Ecchymosis and hematoma as seen before initiation of therapy. B, Initial response to therapy. C, Development of necrosis with bullae

Figure 3

Retrograde Urethrogram. No evidence of stricture or extravasation

Figure 4

Penis at 1‐y follow up visit. A, Dorsal view, (B) left lateral view, (C) ventral view with patent meatus and scrotum