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50.4 Roman andByzantium Empires
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Fig. 50.1 Cult of Cybele
castration clamp (Public
Domain). Bronze Clamp
from River Thames at
London Bridge. Room of
Roman Britain, Case D,
British Museum. J scale
413
in a radical manner consisting of total removal of testes and penises. Such a radically castrated young boy was notoriously known as “Carzimasium”. According to
Grabowski, the Jewish origin of this name suggests that certain Jews were involved
in the commerce of Eunuchs during that period [9]. However, it is important to
remind our readers that castration is absolutely proscribed in the Hebraic religion,
and Eunuchs are not accepted as priests. Indeed, this fact is unequivocally written in
Deuteronomy 23:1 “No one who has been emasculated by crushing or cutting may
enter the assembly of the Lord.”
In Christianity also, the First Council of Nicaea in 325 has formally forbidden
whoever has undergone a voluntary emasculation to enter the priesthood, but this
did not discourage fanatics to continue a literal interpretation of Matthew Gospel,
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19:12 “For there are eunuchs who were born that way, and there are eunuchs who
have been made eunuchs by others, and there are those who choose to live like
eunuchs for the sake of the kingdom of heaven. The one who can accept this should
accept it” [1, 10].
50 Male Castration inHistory
50.5 Medieval Europe
In the Middle age, all of Europe was practicing castration either as a punishment or
as preventive or curative treatment for various conditions such as leprosy, dementia,
epilepsy, hydrocele, inguinal hernia, gout, and certain inammatory diseases [1].
Furthermore, the interest to castrate younger boys between 7 and 12years in order
to preserve their soprano voice also grew with time, despite the poor anesthetics
means and a mortality varying from 10% to 80% [1].
50.6 Islamic Ottoman Empire
Like Hebraic religion and Christianity, castration is also absolutely forbidden in
Islam, either for free men or for slaves. Yet the presence of eunuchs was commonplace in Abbasside caliphates and the Ottoman Empire. From the sixteenth century,
an increasing number of Eunuchs came to Istanbul from Africa, and by the nineteenth century, all eunuchs were slaves from outside the Empire [11].
50.7 Pre-Columbian America
Despite the existence of the transsexual phenomenon in ancient native Americans
with the so-called Berdaches or “two-spirit,” there is no robust evidence that these
populations were performing self-emasculation to realize their will [12].
50.8 Imperial China
Castration and its corollary eunuch system are thought to have existed in Imperial
China all over its 25 dynasties, covering an approximate period of 4000years, only
to disappear by the early twentieth century with the overthrowing of the last Emperor
[13]. It is estimated that the total number of Eunuchs reached a 100,000 at the time
of the establishment of the Qing dynasty in 1644, while the total empire population
was 130 million people [14]. And this phenomenon has reached a so high magnitude that Historians and commentators referred to late Imperial China as a
“Castrated civilization” [15]. In addition, many Chinese eunuchs were slaves
50.8 Imperial China
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415
being trusted in the royal court and utilized their position to gain political power. By
the last period of the Ming dynasty (1368–1644CE), they had established a nearly
complete domination of the imperial court, and four infamous dictators in that
period, namely Wang Zhen, Wang Zhi, Liu Jin, and Wei Zhongxian were all eunuchs
[16, 17]. In China, castration involved the total removal of external genitalia (testes
and penis) at the same time, and with increased experience, the mortality rate was
lower (2%) than in other countries (25% or higher) [13].
Many families castrated their own children, and many young adults voluntarily
underwent the same mutilation for socio-economical purposes, aiming at being
employed as servants and getting protection in the Royal Palace (Fig. 50.2).
Castrates were providing material advantages to their relatives; however, they were
referred to as “Chujia” (leaving home) and their return home was considered too
shameful for their families [18]. The last Imperial eunuch, Sun Yaoting, who died in
December 1996 at the age of 94, was himself castrated at the age of 8 to save his
father from bankruptcy [18].
Fig. 50.2 The Empress Dowager Cixi (1835–1908) in sedan chair carried and surrounded by
eunuchs in front of Renshoudian, Summer Palace, Beijing. (Photographer: Xunling, 1874–1943.
(Public domain))
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50 Male Castration inHistory
50.9 Early Modern England
There are many reports from the seventeenth and eighteenth centuries referring to
self-castration and phallectomy in England, probably with religious delusions. This
practice was however considered very shameful and humiliating by English society [19].
50.10 Russia
Founded by a fugitive peasant, Kondratii Selivanov, in around the 1760s, the
Skoptsy, also called the White Doves, were a Christian sect in the Russian Empire
that was encouraging genital self-amputations (orchidectomy with or without phallectomy for males, and mastectomy with clitoridectomy and excision of the labia
majora for females) to attain purication. Male members of the sect had a choice
between either the “great seal” (removal of the penis, the scrotum, and the testes)
or the “lesser seal” (removal of the scrotum and testes, leaving the penis intact)
(Fig.50.3). They did so to atone for the so-called original sin committed by Adam
Fig. 50.3 Skoptsy man and woman with “greater seal”. (Public domain)
50.12 Australia
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and Eve through their genitals and were also referring to the early mentioned
Mathew gospel 19:12. Obviously, adepts of this sect literally interpreted the last part
of this verse not only as a spiritual purication but also as physical castration. The
Skoptsy were severely persecuted by the Tsar governments and later by the Soviet
authorities and started declining in the nineteenth and twentieth centuries. Today the
sect is believed to have completely disappeared [20, 21].
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50.11 India
The hijra (eunuch/transvestite) is a well-known institutionalized third gender in
India. In 2014, a Supreme Court verdict ordered that Hijras should be recognized
under a separate “third gender” category [22]. However, it is important to know that
among Hijras, there is a minority born with ambiguous genitalia (Khusra), while the
majority are unequivocally born males, then self-castrate (Khoja/Chhinni) through
a process called “Nirvan” to attain purication for the cult of the Mother Goddess
Bahuchara Mata. Besides these two categories, there are also cross-dressers or
transvestites (Aqua), impotent male homosexuals or bisexuals (Zananay), or even
biological true female with false Hijra identity (Chhibri) [22].
In view of the above facts, it became obvious to some researchers that many
hijras are prostitutes, undermining the valued sacred role of their devotion [22–24].
By 2012, the estimated number of Hijras was ve to six million in India but they are
still a marginal community living in ghettos [22, 25].
50.12 Australia
Some aborigines traditionally perform urethrotomy by incising the undersurface of
the penis. They do so in a stepwise manner starting at younger ages until adulthood
to complete the incision which starts from the external meatus up to the base of the
scrotum, resulting in a long ventral urethral slit. To date, the reason for this incision
is still subject to debate. Speculations include hygiene reasons, contraceptive measures as the semen would ow too proximally to enter the vagina, enhancement of
self-sexual stimulation for males with increased ventral sensation, or a desire to
stimulate the females with a larger penile girth on erection, etc. [26–28].
Another proposed explanation is that aborigines’ ancestors envied male kangaroos’ penises which were believed to be anatomically bifurcated to adapt to the
complex vaginal system of the female marsupials (two lateral vaginas for sperm
carriage to the two uteruses, and one middle vagina for joey birth) [27]. However,
modern studies disproved this fact and demonstrated that Kangaroos have unsplit
penises [29], but many other marsupial species such as the Koala do effectively have
bifurcated penises.
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50 Male Castration inHistory
50.13 Famous Eunuchs inHistory
Although non-exhaustive, the following list portrays the fact that Eunuchs, either
forced or voluntary, originated from various cultures, professions, and social positions, and embodied different personalities. This should always be borne in mind
when facing a case of self-castration.
• Pothinus (First century BC): Pothinus was the regent for the underaged
Pharaoh Ptolemy XIII Theos Philopator, who co-ruled Egypt with his sister and
wife Cleopatra VII after the death of their father Ptolemy XII.
• Sporus (First century CE): He was one of the most known eunuchs in Roman
history. This young man was favored, castrated, and ofcially married by
Emperor Nero in the year 67 after the death of his wife Poppeae Sabina [30].
• Cai Lun (First to Second century CE): He is traditionally regarded as the
inventor of paper and the modern papermaking process. It is enough to realize
that had Cai Lun not invented the paper, Johannes Gutenberg would not have
invented his mechanical printing press at around 1440, mass communication
would not have been possible at that time, and Renaissance would not have hap-
pened in Europe in the fteenth Century.
• Origen of Alexandria (185–254): Origen was considered the most brilliant
Christian scholar and Theologian for centuries. As an ascetic, he reportedly self-
castrated at a young age to freely work in instructing female catechumens.
However, this version is not universally accepted [31].
• Narses (Fifth to Sixthcentury CE): A Romanized Armenian, Narses was one of
the Great Generals in the service of the Byzantine Emperor Justinian I.
• Peter Abelard (1079–1142): Abelard was a famous French Philosopher, logi-
cian, and teacher who fell in love with his pupil Héloïse and had an affair and a
son with her. Héloïse’s uncle, Canon Fulbert then obliged Abelard to marry
Héloïse in order to repair the dishonor and cover the shame. However soon after
their marriage, Abelard, embarrassed and aiming at protecting his own reputa-
tion, sent his wife to a convent. This provoked Fulbert’s furor, who felt betrayed
and punished Abelard by getting him assaulted and castrated [32].
• Zheng He (1371–1433): This Chinese mariner, explorer, Admiral, and Diplomat
during the Ming Dynasty, was born in a Muslim family under the name “Ma He.”
He was captured and castrated at the age of 10years soon after China recon-
quered Yunnan, the last territory held by Mongols [33].
• Judar Pasha (1550–1606): This Spanish-born man was captured and castrated
by Muslim Slave-raiders as a young boy. His original name was Diego de
Guevara. He became a Moroccan military leader who notoriously conquered the
Songhai Empire, with its historical cities Gao, Djenné, and Timbuktu (today
located in the Republic of Mali).
• Wei Zhongxian (1568–1627): Wei is considered as the most powerful and most
notorious eunuch in Chinese history. He castrated himself at the age of 21 to
enter the Royal court where he became progressively inuential to the point that
he took maximum advantage of the Tianqi Emperor’s (Zhu Youjiao) weakness to
References
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419
become the actual ruler by the end of his life along with the Emperor’s wet nurse
Madam Ke [34].
• Thomas “Boston” Corbett (1832–1894): Corbett was a Union Army soldier
who killed President Abraham Lincoln’s assassin, John Wilkes. He was a fervent
Christian, and in 1858, he was ogled by two prostitutes on his way back from a
church meeting and got some sexual excitation. This encounter strongly dis-
turbed him to the point that when he reached home, he deeply meditated about
the Gospel of Mathew 19:12 (see above) and 5:29 ‘And if thy right eye offend
thee, pluck it out, and cast it from thee: for it is protable for thee that one of thy
members should perish, and not that thy whole body should be cast into hell’. He
immediately understood what he had to do and castrated himself with a pair of
scissors as atonement [35]. After this act, he remained calm, continued praying,
had dinner, then took a light stroll through the city before reporting to the hospi-
tal as the last, but also the least of his concerns.
• Alessandro Moreschi (1858–1922): This famous Italian castrato singer of the
late nineteenth century was also known as the “Angel of Rome” [36, 37].
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2. Jonckheere F. L’Eunuque dans l’Égypte pharaonique. Revue d’Histoire des Sciences.
1954;7(2):139–55.
3. Hong CC, Ediger RD.Self-mutilation of the penis in C57BL/6N mice. Lab Anim. 1978;12:55–7.
4. Taylor G.Castration: an abbreviated history of western manhood. New York: Routledge;
2002. p.285.
5. Photis Theodoropoulos. https://www.quora.com/What- was- the- role- of- eunuchs- in- Ancient-
Greek- society.
6. Kontani Y.Castration under Roman Law: a study of the codication during the Reign of Justinian
I (527–565). Ancient Soc. 2018;48:305–31. https://doi.org/10.2143/AS.48.0.3285205.
7. The Panarion of Epiphanius of Salamis: Sects 47–80, De Fide By Epiphanius, p 98–100.
Epiphanius of Salamis. Panarion. p4.38.1–4. Translated by Frank Williams in The Panarion
of Epiphanius of Salamis. NewYork: E.J.Brill; 1987. https://people.well.com/user/aquarius/
epiphanius- panarion- de.htm.
8. Hopkins K. Eunuchs in politics in the later Roman Empire. Proc Camb Philol Soc.
1962;9:62–80.
9. Grabowski A.Eunuch between economy and philology. The case of carzimasium. In: Mélanges
de l’École française de Rome—Moyen Âge [En ligne]; 2015. p.127–31.
10. Caner DF. The practice and prohibition of self-castration in early Christianity. Vigiliae
Christianae. 1997;51(4):396–415.
11. Toledano ER.The Imperial eunuchs of Istanbul: from Africa to the heart of Islam. Middle East
Stud. 1984;20(3):379–90. Accessed 7 Apr 2021.
12. Boag P. Sexuality, gender, and identity in great plains history and myth. Great Plains
Q. 1998;1998:1271.
13. Eng JT, Zhang Q, Zhu H.Skeletal effects of castration on two eunuchs of Ming China.
Anthropol Sci. 2010;118:107–16. https://doi.org/10.1537/ase.090430.
14. Tsai S.The demand and supply of Ming eunuchs. J Asian Hist. 1991;25(2):121–46. http://
www.jstor.org/stable/41930824. Accessed 7 Apr 2021.
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15. Chiang H. How China became a “castrated civilization” and eunuchs a “third sex”. In:
Chiang H, editor. Transgender China. New York: Palgrave Macmillan; 2012. https://doi.
org/10.1057/9781137082503_2.
16. Cartwright M. Eunuchs in Ancient China. World History Encyclopedia. 2017. Web 25
Jun 2021.
17. Crawford R.Eunuch power in the Ming dynasty. T’oung Pao. 1961;49(3, second series):115–48.
18. Chatterton J, Bultitude M.Castration; The eunuchs of Qing dynasty China; a medical and
historical review. de Historia Urologie Europace. 2008;15:39–47.
19. Skuse A. ‘One stroak of his razour’: tales of self-gelding in early modern England. Soc Hist
Med. 2020;33(2):377–93.
20. Engelstein L.From heresy to harm: self-castrators in the civic discourse of late tsarist Russia.
In: Castration and the Heavenly Kingdom: a Russian folktale. Cornell University Press; 2003.
21. Tulpe IA, Torchinov EA.The Castrati (“Skoptsy”) sect in Russia: history, teaching, and religious practice. Int J Transpers Stud. 2000;19(1):77–87.
22. Mal S.The hijras of India: a marginal community with paradox sexual identity. Indian J Soc
Psychiatry. 2018;34:79–85.
23. Nanda S.The hijras of India: cultural and individual dimensions of an institutionalized third
gender role. J Homosex. 1985;11(3–4):35–54. PMID: 4093603.
24. Lal V.Not this, not that: the hijras of India and the cultural politics of sexuality. Social Text.
1999;61:119–40.
25. Kalra G.Hijras: the unique transgender culture of India. Int J Cult Ment Health. 2012;5:121–6.
26. Cawte JE, Djagamara N, Barrett MG.The meaning of subincision of the urethra to aboriginal
Australians. Br J Med Psychol. 1966;39:245–53. https://doi.org/10.1111/j.2044- 8341.1966.
tb01334.x.
27. Singer P, Desole D.The Australian subincision ceremony reconsidered: vaginal envy or kangaroo bid penis envy. Am Anthropol. 1967;69(3/4, new series):355–8. http://www.jstor.org/
stable/669931. Accessed 5 Apr 2021.
28. Pounder DJ.Ritual mutilation. Subincision of the penis among Australian Aborigines. Am J
Forensic Med Pathol. 1983;4(3):227–9.
29. Warburton NM, Bateman PW, Fleming PA.Anatomy of the cavernous muscles of the kangaroo penis highlights marsupial-placental dichotomy. J Anat. 2019;234(3):306–15. https://doi.
org/10.1111/joa.12930. Epub 2019 Jan 6. PMID: 30613968; PMCID: PMC6365618.
30. Woods D.Nero and Sporus. Latomus Revue d’etudes Latines. 2009;68(1):73–82.
31. Chadwick H.Origen. Encyclopedia Britannica. 2020. https://www.britannica.com/biography/
Origen. Accessed 8 Apr 2021.
32. Guillaumard F.Le travail de l’écriture d’Héloïse dans ses lettres à Abélard. Analyse Freudienne
Presse. 2005;2(2):153–66. https://doi.org/10.3917/afp.012.0153.
33. Lo J-p. Zheng He. Encyclopedia Britannica. 2021; https://www.britannica.com/biography/
Zheng- He. Accessed 9 Apr 2021
34. Britannica, The Editors of Encyclopaedia. Wei Zhongxian. Encyclopedia Britannica. 2021.
https://www.britannica.com/biography/Wei- Zhongxian. Accessed 8 Apr 2021.
35. Jensen B. The insane story of the guy who killed the guy who killed Lincoln. Meet
Boston Corbett, the self-castrated hatmaker who was John Wilkes Booth’s Jack
Ruby. Published online in April 2015. https://www.washingtonian.com/2015/04/12/
the- man- who- killed- john- wilkes- booth/.
36. Clapton N.Moreschi and the voice of the castrato. London: Haus; 2008. p.60–2.
37. Koutsiaris EA, Alamanis C, Eftychiadis A, Zervas A.Castrati singers: surgery for religion and
art. Ital J Anat Embryol. 2014;119(2):106–10. PMID: 25665280
50 Male Castration inHistory
Male Genital Self-Mutilation
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intheModern Medical Literature
Many authors refer to the phenomenon of male genital self-mutilation as “Klingsor
Syndrome” or “Eshmum Complex.” The rst eponym comes from a ctitious
character in the Wagner’s opera “Parsifal” where Klingsor was a magician who
castrated himself in an unsuccessful attempt to gain acceptance from the Knights of
the Grail [1]. The second one comes from the legendary beautiful young man mentioned above in the Phoenician mythology (see Chap. 49).
While exclusively concentrating on the male aspect of this malady in the present
work, it should be borne in mind that the female counterpart of this phenomenon has
also been reported in the modern medical literature, but articles are extremely scanty
[2, 3]. Furthermore, a psychiatric pathological entity consisting of female genital
self-mutilations, dysorexia, and a hysterical personality has been proposed as
Caenis Syndrome. This eponym refers to Caenis, who was the loveliest of all girls
in Thessaly but refused to marry anyone and was abducted and raped by Poseidon
(or Neptune), the God of the Sea. Poseidon then offered her one wish, and she
demanded to be changed into a man so that she might never be wronged again [4].
It is generally assumed that the rst case of GSM in the modern literature was
reported by Daniel Stroch in 1901 [5]. However, there is an older report authored by
MacDonald in 1884 [6] about a 50-year-old Indian cultivator who auto-inicted a
bilateral orchidectomy and presented after 36h. After local treatment according to
available antiseptic means in that pre-antibiotic era, the patient’s condition needed
almost 40days to improve, only to allow him to be sentenced by a court to 7 days’
imprisonment for this self-inicting injury.
Many cases were soon reported in the twentieth century, lifting the veil on this
phenomenon, and enriching the modern medical literature, with an increasing trend
that continues to date (Fig.51.1). By the time this review was concluded, there were
not less than 246 articles written, for a total of 337 cases arising from all 6 inhabited
continents, comprising individual case reports and monocentric series.
51
© The Author(s), under exclusive license to Springer Nature Singapore Pte
Ltd. 2023
S. A. AL-Mamari, Urogenital Trauma: A Practical Guide,
https://doi.org/10.1007/978-981-99-6171-9_51
421
422
Upto 1950
1951-1960 1961-1970 1971-1980 1981-1990 1991-2000 2001-2010 2011-2022
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17
Fig. 51.1 Number of GSM cases per decade (total 337)
9
51 Male Genital Self-Mutilation intheModern Medical Literature
120
72
51
37
5
26
Not strictly considered as amputations, cases of urethral foreign bodies insertion
should not be considered as GSM as well as those of self-insertion of plastic spherules in the penile skin reported in Japanese racketeers known as “Yakuza” [7].
Overall, apart from the Hijras in India, male GSM remains sporadic. However, a
series study in a single tertiary hospital in the USA over a 5-year period revealed a
total of 118 cases with male genital trauma, of whom 39% (46 patients) had a penetrating injury and 61% had a blunt trauma. Among the penetrating injury, the most
common mechanism was external violence (48%) and self-inicted injury (40%).
Hence, 18 cases of GSM were recorded in that period, giving an average of more
than 3 patients per year [8].
In addition to hundreds of sporadic case reports here and there, there is a handful
of review articles treating this phenomenon, the latest three being written in 1979,
1996, and 2017, and inventorying 53, 98 cases, and 173 cases, respectively [9–11].
There have been also a dozen series treating this phenomenon. The oldest was
written by Bigot in 1938 (cited from Hemphill 1951) about ten Indochina Buddhists,
aged from 20 to 70years, who self-amputated their penises to prevent incestuous or
immoral acts or from indulging in sexual thoughts [12]. One by one, more series
continued to be reported with slowly increasing sizes [13–16]. Review articles have
also been published addressing the psychiatric aspect of major self-mutilations in
general [17, 18] or the GSM aspect in particular [19, 20].
There have also been many online surveys addressing the motivations behind
castration [21–25], while others were specic to men who performed voluntary
penectomy with testicular preservation [26] or to responses to orchidectomy [27].
Authors also published reviews and meta-analysis about the penile replantation outcome [28], and the cosmetic and functional results [29].
Reports came from all the continents, especially North America, Europe, and
Asia (India, Japan). Christian and Asian Polytheist worlds have shown the highest
incidence of GSM. Arabic countries did also report dozens of cases, especially
Morocco which has published the highest number of male GSM in the Islamic
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