You'd have lots of patients willing to get a gun and blow off their own genitals if you don't do it. I've had several who got knives and cut themselves trying to get rid of their sex organs. Perhaps better than all else, I understand obsession. It is of the mind. And it is language-bound.
Sex is of the body.
It has no words. I am stunned to learn that someone with an obsession of the mind can have parts of the body surgically removed. This is my brother I speak of. This is not some lunatic named Carl who becomes Carlene. This is my brother.