Penile Tourniquet Injury and Schizoaffective Disorder: A Case Report

Medical literature has documented a rare but severe clinical phenomenon known as hair tourniquet syndrome and related penile strangulation, which can lead to significant tissue damage, ischemia, and in extreme cases, autoamputation.

A case report published by Cureus describes a penile tourniquet injury in a patient with schizoaffective disorder who presented with altered mental status. This case highlights the intersection of acute psychiatric crises and urgent urological emergencies.

Understanding Tourniquet Injuries

Hair tourniquet syndrome occurs when a strand of hair or thread becomes wrapped around an appendage. This creates a constricting band that can restrict blood flow, leading to injury that may progress to ischemia, necrosis, or autoamputation.

In pediatric cases, such as one reported in 2022 in Urol Case Rep, a 2-year-old uncircumcised male presented with erythema at the base of the penis, which progressed to a bleeding wound. In that specific instance, the tourniquet resulted in the circumferential separation of the shaft skin, though it occurred without vascular compromise.

Psychiatric Context and Self-Inflicted Injury

While some tourniquet injuries are accidental, others are self-inflicted, often associated with severe psychiatric disorders. Research indicates that genital self-mutilation is a rare but severe form of self-inflicted injury most commonly linked to schizophrenia.

Reports from the International Journal of Surgery Case Reports and Annals of Medicine and Surgery have detailed various forms of self-harm in psychotic contexts. These include:

• Penile strangulation using materials such as rubber bands.
• Complete amputation of the penile glans.
• Severe penile injuries requiring urgent urological intervention.

One case report detailed a 38-year-old male with schizophrenia who presented to an emergency department in June 2025 after a self-inflicted complete amputation of the penile glans during an acute psychotic episode. The patient was found to be hemodynamically stable with a clean transection.

Clinical Challenges and Management

The management of these injuries presents significant surgical and psychiatric challenges. Because these events often occur during acute psychotic episodes or periods of altered mental status, patients may not be able to accurately describe the timing or nature of the injury.

Medical providers must address two critical needs simultaneously: urgent urological intervention to save viable tissue and psychiatric stabilization to prevent further self-harm.

The integration of surgical and psychiatric care is considered essential to optimize patient outcomes. Without rapid intervention, the constriction caused by a tourniquet or the trauma of a self-inflicted wound can lead to permanent loss of function or tissue death.

Prognosis and Risk Factors

While complete genital mutilation remains an exceptionally rare event, the risk is heightened in populations with poorly managed psychiatric disorders. The presence of altered mental status can further complicate the clinical picture, as it may mask the severity of the injury or delay the patient’s arrival at a medical facility.

The severity of the outcome depends largely on the duration of the constriction or the precision of the injury. In cases of strangulation, the primary goal is the immediate removal of the constricting band to restore blood flow and prevent necrosis.