Male genital self-mutilation with maggot infestation in an intoxicated individual

We present the case of a 55-year-old homeless male who presented with penis and scrotal maggot infestation secondary to genital self-mutilation. The patient gave a history consistent with gender identity disorder and indicated that he was intoxicated during the event. The patient had no history of psychosis. He sought medical attention only after he was no longer welcome on public transportation due to the odor emanating from this infection. Untreated gender identity disorder with alcohol dependence in this case led to a drastic behavior with significant consequences.