Introduction. A number of men have extreme castration ideations. Many only fantasize about castration; others actualize their fantasies.
Aims. We wish to identify factors that distinguish those who merely fantasize about being castrated from those who are at the greatest risk of genital mutilation.
Methods. Seven hundred thirty-one individuals, who were not castrated, responded to a survey posted on http://www.eunuch.org. We compared the responses of these “wannabes” to those of 92 men who were voluntarily castrated and responded to a companion survey.
Main Outcome Measures. Respondents answered the questionnaire items relating to demographics, origin of interest in castration, and ambition toward eunuchdom.
Results. Two categories of wannabes emerged. A large proportion (∼40%) of wannabes' interest in castration was singularly of a fetishistic nature, and these men appeared to be at a relatively low risk of irreversible genital mutilation. Approximately 20% of the men, however, appeared to be at great risk of genital mutilation. They showed a greater desire to reduce libido, change their genital appearance, transition out of male, and prevent sexually offensive behavior. Nineteen percent of all wannabes have attempted self-castration, yet only 10% have sought medical assistance.
Conclusions. We identify several motivating factors for extreme castration ideations and provide a classification for reasons why some males desire orchiectomies. Castration ideations fall under several categories of the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV), most notably a Gender Identity Disorder other than male-to-female (MtF) transsexual (i.e., male-to-eunuch) and a Body Identity Integrity Disorder. Physicians need to be aware of males who have strong desires for emasculation without a traditional MtF transsexual identity. Roberts LF, Brett MA, Johnson TW, and Wassersug RJ. A passion for castration: Characterizing men who are fascinated with castration, but have not been castrated. J Sex Med 2008;5:1669–1680.