from the beginning of the century to this day , 57 cases of male genital self - mutilation ( gsm ) have been reported in the english literature . in german publications although no precise data are available on the prevalence of male gsm , such acts are presumably much more frequent than the small number of published cases would suggest . in the literature , several features are regarded as risk factors for self - mutilation , such as homosexual or transsexual tendencies , repudiation of the male genitals , absence of a competent male for identification during childhood , feeling of guilt for sexual offences , and self - injury . a 35-year - old man was referred to the outpatient department , with self - inflicted penile incised wound caused with razor blade 1 month back . the patient acknowledged frequent altercations and verbal abuse by the owner of the company . his marriage produced no children , and he described his marital relationship as amicable and sexually gratifying . his mental status examination was significant for his masculine appearance , gregariousness , and lack of distress . there were no signs of thought - process disorganization , internal preoccupation , or delusional focus in his presentation material . there was no past or family history of any psychiatric illness , chronic medical illness or drug misuse . the physical examination revealed an average built patient ( weight 43.5 kg , height 158 cm ) and an older superficial laceration ( 25 cm ) at the right prepuce with circumferential incised wound over root of glans . psychological testing corroborated the absence of psychosis and the likelihood of a primary severe personality disorder . dialectical behavior therapy ( dbt ) was given to the patient to teach the patient skills to cope with stress , regulate emotions and improve relationships with others . about 110 cases of gsm in men have been described in the literature ( greilsheimer and groves , martin and gattaz , and nakaya aboseif et al . , becker and hartmann , ) . in the earlier publications , the majority of these patients were either psychotic or intoxicated during automutilation ( greilsheimer and groves ) . in recent articles , the number of psychotic patients has been reported to be smaller ( becker and hartmann ) . the authors discuss that this might be due to a double bias as psychiatrists are more frequently involved when the patients are psychotic and these cases tend to be published more frequently . psychotic patients with delusions ( often religious ) , sexual conflict associated with guilt , past suicide attempts or other self - destructive behavior and depression , severe childhood deprivation , and major premorbid personality disorder are the group at risk for genital self - amputation . it has been proposed that the eponym , the  klingsor  syndrome , be applied only to acts of genital self - mutation involving religious delusions . a review showed that guilt feelings associated with sexual conflicts were the most important factors in the act of psychotic self - mutilation and were also related to religious psychotic experiences that were often the direct motives for the act . self - mutilators with sexual guilt feelings were likely to mutilate themselves more severely than those without ( nakaya ) . even excluding the transsexuals , disturbance of sexual identity was most participating in the act of nonpsychotic self - mutilators . in addition to these , previous history of self - injury took part in the act independently . male genital self - mutilation is exceedingly rare in psychiatric practice , even if it is not as uncommon as the paucity of published literature on the subject would suggest . men who intentionally mutilate or remove their own genitals are likely to be psychotic at the time of the act , to have a number of goals and aims relating to conflicts about the male role , and to be vulnerable to sociocultural and psychological forces in a causal network as yet unknown . however , from a review of the cases of 53 male self - mutilators , it appears that a significant number involves individuals not psychotic at the time of the act but rather having character disorders and rageful feelings toward themselves or women , and transsexual males who premeditate their own gender conversion surgery . suyemoto and macdonald reported the incidence of self - mutilation in adolescents and young adults between the ages of 15 and 35 to be an estimated 1800 individuals out of 100,000 . self - mutilation has been most commonly seen as a diagnostic indicator for borderline personality disorder . self - mutilating behavior has been studied in a variety of racial , chronological , ethnic , gender , and socioeconomic populations . people who participate in self - injurious behavior are usually likeable , intelligent , and functional . at times of high stress , these individuals often report an inability to think , the presence of inexpressible rage , and a sense of powerlessness . an additional characteristic identified by researchers and therapists is the inability to verbally express feelings . in our patient , this aggressive component seems to have been directed against himself , which can mainly be explained by his low self - esteem and insecure personality structure .
psychiatric case reports of male genital self - mutilation ( gsm ) in the literature are rare and mostly anecdotal . 
 most of them are connected with personality disorders ( goldfield and glick , 1970 ; wise et al . , 1989 ) . 
 in men , psychosis is an important cause for gsm , causing up to 80% of automutilations .