A man from Thailand completely amputated his penis in an episode of cannabis-induced psychosis, according to a new case report.
Reported in the Journal of Medical Case Reports, the 23-year-old man had been using cannabis for two years before discontinuing the drug for a period of three months. Following this, he began using cannabis again, smoking about 2 grams using a bong.
During this session, he experienced an erection unrelated to any sexual stimulation and started to feel sharp pains in his penis. The man, who had no prior history of psychiatric illness or other mental health problems, reported that the glans of his penis "looked distorted".
"Intending to eradicate the pain," the authors write, "he decided to trim the penile skin several times and completely amputated his penis himself using scissors."
The man was aware of the process as it was happening, he later reported to doctors, and attended the emergency room after the bleeding had not stopped after two hours. In the hospital, the team was able to control the bleeding. However, they were unable to reattach the penis as it was deemed "too dirty and fragile for reconstruction".
"The remaining penile stump was 2 cm in length with loss of the whole penile skin," they wrote. "The amputated distal part of the penis was contaminated with ants."
While recovering, the man was submitted to psychiatric evaluations, to determine the cause of this episode.
"His mental status examinations found he had visual and auditory hallucinations, such as seeing moving shadows, hearing birds chirping or insects buzzing, depressed mood, and restricted affect," they write, noting "he was coherent and delusional, with no suicidal ideas."
The man reported use of cannabis only, which a test of his urine confirmed, with no other drugs or alcohol present. No other underlying diseases or a family history of mental illness was found. Within four weeks of ceasing to use cannabis, his psychotic symptoms resolved, and the team diagnosed him with cannabis-induced psychosis — a rare adverse effect of cannabis. The team noted there have been around a hundred cases in the last two decades.
They also noted that the man could have had a case of priapism — where an erection lasts longer than four hours, despite an absence of sexual stimulation — or it could have been an adverse (subjective) effect of the cannabis. However, they could not diagnose him with either, as the penis was removed before four hours had elapsed.
The man was offered a penoplasty (surgery to lengthen the penis), but has since relocated and has been unavailable to talk to the team.