Abstract / Summary
Abstract Introduction : Self-inflicted genital injury is rare and typically reflects severe underlying psychiatric morbidity, including psychosis, obsessive-compulsive disorder (OCD), gender dysphoria, and major depressive disorder (MDD). Reports from Arab and sub-Saharan contexts remain scarce, despite evidence that stigma and limited access to integrated psychiatric and gender-affirming care increase the risk of irreversible, non-medical intervention. We describe a case illustrating this intersection in a previously undiagnosed young man. Case Presentation: A 22-year-old Sudanese university student presented with chronic insomnia and depressive symptoms superimposed on a five-year history of untreated, contamination-related obsessive-compulsive disorder. He later disclosed longstanding, concealed gender dysphoria and guilt-laden obsessions centred on eliminating sexual desire. Nine months before presentation, he had undergone bilateral orchiectomy performed by an unlicensed practitioner. Sertraline was initiated and titrated to 100 mg daily, alongside a structured suicide-risk assessment and safety plan. Depressive symptoms and compulsive rituals improved over six months, though he continued unsupervised use of informally obtained feminising hormones. Approximately four years after the orchiectomy, he inflicted penile amputation at home, resulting in severe haemorrhage and emergency hospitalisation. Conclusions : This case, among the first reported from Sudan, highlights the risks of fragmented, delayed psychiatric care in patients with concealed gender dysphoria and obsessive-compulsive symptoms, and underscores the need for early, culturally sensitive, multidisciplinary evaluation to prevent irreversible harm.