title: The emerging trend of self-circumcision and the need to define cause: Case report of a 21 year-old male.
abstract: BACKGROUND
  Male 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.
  
  
  METHODS
  A 21year old male circumcised himself using a razor-blade 13days prior to presentation at the hospital. He attributes this to reluctance to have him circumcised. He sustained extensive penile skin denudation of 7cm 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.
  
  
  CONCLUSIONS
  Such 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.
  
  
  CONCLUSIONS
  Cases 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.
authors.affiliation: State Hospital, Kuajok, South Sudan; Directorate of Surgery, Mulago National Referral Hospital, Kampala, Uganda. Electronic address: kintu2r@gmail.com.
authors.forename: Ronald
authors.initials: R
authors.lastname: Kintu-Luwaga
keywords: Causes; Complications; Disease burden; Self-circumcision