Indian Journal of Psychiatry, 2001,43(4),342-344 GENITAL SELF AMPUTATION FOR URINARY SYMPTOM RELIEF OR SUICIDE? BAIKUNTHANATH MISHRA & NILAMADHAB KAR ABSTRACT Complete combined amputation of penis and scrotum has been rarely reported.A case of an elderly male with complete genital mutilation is presented with the complexities of the phenomena. He was suffering from severe depressive episode and had experienced multiple events related to urinary system. His vulnerability to self injurious behaviour had been established by past suicide attempt. Gross impairment of judgement and depressive cognitions were instrumental in precipitating such behaviour. Related literatures are discussed. Key Works: Genital self mutilation, depression, urinary symptoms, suicide Genital self-mutilation is an uncommon phenomenon. Extents of injuries vary from simple laceration to amputation (Aboseif et al,1993). However most cases represent an isolated penile mutilation. Complete combined amputation of penis and scrotum has been rarely reported (Becker & Hartmann, 1997). We describe a case of complete self-amputation of genitalia with the complexities of the phenomenon. CASE REPORT A 56-year-old Hindu married.male working as an government officer was suffering from recurrent depressive disorder from the age 39 and was experiencing yet another depressive episode. He was prescribed imipramine 75 mg per day along with other medicines for sedation. Within 3 days he has obstructive urinary symptoms . Imipramine was replaced by fluoxetine.Clinical examination and investigation revealed grade one benign hypertrophy of prostrate.high residual urine of around 200 ml without back pressure effect.There was no urethral stricture. He experienced incontinence of urine occasionally. Around a week after, he was admitted in the emergency surgical ward with his scrotum,penis completely amputated. He had cut off his genitals along with skin and superficial tissue of a portion of lower abdominal wall immediately above penis through several strokes using a shaving blade. He was conscious and described the act as a way to get rid of his urinary problem of incontinence and consequent social embarrassment. He denied this being a suicide attempt even though he had death wishes and suicidal ideas. He did it in his secluded drawing room where the chance of being discovered was less. He did not seek help. He did not complain of pain. He was seen unperturbed. He showed no regret. There was no obsessions or guilt feeling regarding sex. His judgement was severely impaired. He expressed hopelessness. He was feeling helpless and considered himself worthless. He was much worried about the incontinence and particularly worried about social embarrassment. He had no imperative hallucinations,religious delusions or any other psychotic features. He had significant worsening of mood in morning, decreased sleep,decreased appetite,loss of 342