Voluntary Genital Ablations: Contrasting the Cutters and Their Clients

Abstract

IntroductionSome healthy males voluntarily seek castration without a recognized medical need. There are currently no standards of care for these individuals, which cause many of them to obtain surgery outside of a licensed medical setting. We seek to understand who performs these surgeries.AimThis study aims to characterize individuals who perform or assist in genital ablations outside of the healthcare system.MethodsA cross-sectional Internet survey posted on eunuch.org received 2,871 responses. We identified individuals who had performed or assisted in human castrations (“cutters”; n = 98) and compared this group with all other survey respondents (n = 2,773), who had not assisted in castrations. Next we compared the cutters with the voluntary eunuchs. Lastly, because many of the cutters have themselves been castrated, we also divided the physically castrated population (n = 278) into cutters (n = 44) and noncutters (n = 234) and compared them.Main Outcome MeasuresSelf-reported questionnaires were used to collect demographic information, gender identity and presentation, selected childhood experiences, and history of aggressive behaviors, self-harming behaviors, and hospitalization.ResultsDistinguishing characteristics of cutters included: (i) presenting themselves as very masculine, (ii) having had their longest sexual relationship with a man, (iii) growing up on a farm, (iv) witnessing animal castrations, (v) having a history of sexually inappropriate behavior, (vi) having been threatened with genital mutilation as a child, (vii) having a history of self-harm, (viii) being raised in a devoutly Christian household, (ix) having had an underground castration themselves, and (x) having body piercings and/or tattoos.ConclusionsThis study may help identify individuals who are at risk of performing illegal castrations. That information may help healthcare providers protect individuals with extreme castration ideations from injuring themselves or others. Jackowich RA, Vale R, Vale K, Wassersug RJ, and Johnson TW. Voluntary genital ablations: Contrasting the cutters and their clients. Sex Med 2014;2:121–132.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…There are also clinical reports of eunuch individuals who have self-castrated and accounts of patients who have misled medical providers to obtain castration (Hermann & Thorstenson, 2015 ; Mukhopadhyay & Chowdhury, 2009 ). There is no doubt when members of this population are denied access to quality medical treatment, they will take actions that may cause them great harm, such as bleeding and infection that may require hospital admission (Hay, 2021 ; Jackowich et al., 2014 ; Johnson & Irwig, 2014 ). Because of these serious problems and harm caused through self-surgery, surgery by unqualified practitioners or the unsupervised use of medications that affect hormones, it is important health care providers create a welcoming environment and consider various treatment options after careful assessment to avoid the problems that lack of access to treatment and withholding treatment will cause.…”

Exposures to information about castration and emotional trauma before puberty are associated with men’s risk of seeking genital ablation as adults

“…This population, as a whole, has a high rate of genital self-injury. 9 , 27 There are several possible explanations for this. Individuals who injure their genitals may see it as the only means to access proper medical treatment and care such as an orchiectomy.…”

Gender Preference in the Sexual Attractions, Fantasies, and Relationships of Voluntarily Castrated Men

“…It would be ideal if we could have obtained data from men before and after castration in a prospective longitudinal fashion. However, because most voluntary castrations (other than as part of sex-reassignment surgery for male-to-female transsexuals) are done outside the medical system, 51 , 52 it would be ethically and logistically challenging to collect such data.…”