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A 20 year old single man presented to the accident and emergency department after failing in an attempt to circumcise himself. He had previously normal anatomy, and a fully retractile foreskin. He had been “browsing” on the internet and had found a web site1 with written and pictorial instructions for self circumcision techniques. Using a non-sterile craft scalpel and lignocaine (lidocaine) spray, which were “to hand”, he followed these to the letter. On arrival in the department, the patient was in considerable pain, but was haemodynamically stable. There was evidence of venous haemorrhage and examination revealed a ragged incision around the outer preputial skin at the level of the corona, a small plastic “guard” (fig 1) that had been fashioned to protect the glans was also in situ.
A penile block combining lignocaine and bupivacaine allowed appropriate inspection, and circumcision was indicated. This was completed by the duty surgeon, and prophylactic antibiotics were prescribed in view of the less than sterile conditions. He was covered for tetanus. Review at one week showed the wound to be healing without complication.
Inspection of the web site1 shows a vast amount of information on circumcision, suggesting improvement in sexual function and describing the procedure variously as “bloodless”, “painless”, and “easy”. Unfortunately the patient was reluctant to comply with long term follow up to assess any improvement! There are reported links between self castration and psychosis.2 In this event there was no evidence of psychiatric illness and the patient was not referred on. This intriguing case could be considered as a circuitous route to bypass NHS waiting lists.
My thanks to Mr Hugo Dowd for his suggestions and critical review of the manuscript.
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