Man amputates penis while high on cannabis

A Thai man suffering a cannabis-fuelled psychotic episode “completely amputated” his own penis with a pair of scissors, doctors say.

The 23-year-old’s amputated penis “was deemed too dirty and fragile for reconstruction”, leaving him with a “penile stump” and requiring surgery to allow him to urinate, doctors from Chiang Mai University’s Department of Emergency Medicine wrote in the Journal of Medical Case Reports.

They said that while there had been around 100 cases of male genital self-mutilation from psychiatric disorders or substance-induced psychosis over the past two decades, self-amputation of the penis during cannabis-induced psychosis “has rarely been reported”.

“In this case report, we highlight a psychotic condition induced by recreational cannabis use, leading to penile self-amputation in a different manner,” they wrote.

The Thai man, who denied any previous self-harm or psychiatric issues, had smoked cannabis for two years previously and had stopped for three months at the time of the incident.

After smoking two bongs, or about two grams of cannabis, he developed an erection “without sexual stimulation, felt a severe persistent sharp pain in his penis, and reported that his glans looked distorted”.

“Intending to eradicate the pain, he decided to trim the penile skin several times and completely amputated his penis himself using scissors,” they wrote. “He reported awareness throughout the process.”

After two hours “the bleeding had not stopped”, and the man was brought to hospital. “There was active bleeding at the penile base and a 5cm lacerated wound at the scrotum,” the doctors wrote.

“The remaining penile stump was 2cm in length with loss of the whole penile skin. The amputated distal part of the penis was contaminated with ants and had fragile dorsal veins.”

A urologist was consulted for surgical intervention, and the “distal penis was deemed too dirty and fragile for reconstruction”.

“The patient was transferred to the operating theatre for emergency surgery,” they wrote.

“Bleeding was controlled, the penile stump irrigated and debrided, and scrotal urethrostomy was performed. He was admitted to the surgical ward. A psychiatrist diagnosed the patient with substance-induced psychotic disorder.”

The man reported visual and auditory hallucinations, such as “seeing moving shadows, hearing birds chirping or insects buzzing, depressed mood, and restricted affect”, but was ”coherent and delusional, with no suicidal ideas”.

After two weeks, he was able to urinate in a sitting position. A second-stage penoplasty was planned but the man was unavailable for follow-up treatment as he relocated.

“Self-amputation of the penis due to cannabis-induced psychosis, as in our patient, is a devastating event that interferes with the quality of life, such as urination dysfunction or sexual function,” the doctors wrote.

“Although psychosis is a manifestation in cannabis users, the method of self-amputation of the penis in cannabis-induced psychosis varies. Khan et al. reported a case of self-amputation of the penis in a patient with cannabis-induced psychosis whose penis was chopped off by a sharp object. On the other hand, in our patient, the penile skin was trimmed several times and then completely amputated using scissors. Several times of trimming rather than stopping after the first trimming indicated the calm self-harm and persistence due to psychosis.”

They noted that over time, the concentration of THC in illegal cannabis had increased from less than 4 per cent to more than 12 per cent, increasing the risk of psychosis.

Last week, Thailand became the first country in Asia to decriminalise marijuana, although authorities have left a grey area around its recreational use, Time magazine reported.

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Originally published as Thai man ‘completely amputates’ own penis with scissors during cannabis-fuelled psychotic episode