The emerging trend of self-circumcision and the need to define cause: Case report of a 21 year-old male

• Health workers need to appreciate that some people do self-circumcise and present with unusual and fulminant complications, which they should be prepared to handle.
• The number of such cases is gradually increasing. Solving the problem starts with consistent case reporting and documentation. This justifies the efforts to get this case published.
• This article generates discussion on the associated complications. It opens the reader’s mind to the various options of management, and how all this contributes to the surgical disease burden.
• The article stimulates analysis and understanding of the factors prompting such action, including examination of possible causes like stigma or fears that may precipitate psychological distress. This warrants a multi-disciplinary approach to management.

IntroductionMale circumcision is traditionally carried out by ascribed practitioners, so self-circumcision is very rare. It is intriguing why the victims should not seek available modern health care. This article highlights another case of self-circumcision, the related causes, complications and their management. The gradual increase in numbers is contributing to the surgical disease burden.Case presentationA 21 year old male circumcised himself using a razor-blade 13 days prior to presentation at the hospital. He attributes this to reluctance to have him circumcised. He sustained extensive penile skin denudation of 7 cm in length, severe bleeding and pain. He lives close to traditionally-circumcising communities and was once chided by peers for being uncircumcised. He had no evidence of psychosis. He did not use any medications during the procedure. He was managed with analgesics, antibiotics and surgical reconstruction. He was discharged on the second post-operative day and subsequently recovered fully.DiscussionSuch patients face a variety of complications, both the immediate and long term. Some are fatal especially those with systemic effects including haemorrhagic shock and septicaemia associated with gangrene. Timely referral to specialist surgeons is critical, as well as thorough review and control of the causes prompting this practice.ConclusionCases of self-circumcision continue to emerge. There is need to report all cases, explore and manage the possible causes. The stigma uncircumcised males face among circumcised peers may be an important cause. Public health education and improved access to voluntary medical male circumcision services may help to prevent this practice.