Self-injections to increase penile size are becoming increasingly common. The most frequently injected substances are silicone and paraffin,¹ although a wide variety of materials may be used, particularly when the procedure is performed outside of a medical institution. The majority of these cases require surgical intervention, ranging from simple circumcision to more complex flap-based reconstruction.^2,3 In selected situations, however, conservative management may be appropriate an approach that is particularly suitable for young men⁴ although it is not always feasible. Multiple surgical procedures may be necessary to address complications or improve the final aesthetic outcome.^5,6 To our knowledge, we report the first documented case of self-injection with Garamycin^® cream and describe the surgical management performed to preserve both penile function and appearance.

This case report adds to the literature on surgical management options for penile self-injections. It describes the clinical course of a Garamycin^® injection a substance promoted on certain non-medical websites for the purpose of penile enlargement. This report highlights the need to develop more standardized management protocols for such cases.

This case highlights three key aspects of penile self-injection.

First, a wide array of injectable substances is available outside regulated medical frameworks, allowing patients to perform self-injections under non-sterile and unsafe conditions. The most frequently reported agents include silicone and paraffin.¹ Case reports in the literature often describe a delayed onset of local or systemic complications following injection.^5,6

Second, the absence of standardized guidelines for surgical management presents a therapeutic challenge.² Since the treatment of our patient, a systematic review has summarized commonly injected agents, associated risks, and management strategies.⁴ It advocates a conservative approach, particularly in younger patients, favoring serial debridement and, when needed, vacuum-assisted closure (VAC) therapy. In our case, the extent of tissue necrosis necessitated wide excision, precluding conservative management. A two-stage scrotal flap was chosen over a single-stage reconstruction to obtain a longer, more viable flap and promote optimal healing. The final aesthetic and functional outcomes were satisfactory. Residual pilosity on the flap may be managed with laser hair removal if necessary. Conservative approaches are the first way to go, and surgical planning must be tailored to the extent of tissue damage, preservation of neurovascular structures, and the anticipated functional and cosmetic outcomes.

The psychological dimension is critical.⁴ Patients frequently present with penile dysmorphophobia, an inaccurate perception of inadequate penile size. Whether performed in medical or non-medical settings, such procedures rarely lead to sustained improvement in body image. These behaviors often reflect deeper psychological distress.¹⁰ For this reason, psychological evaluation and support should be systematically offered to patients presenting with self-injection related complications. Even when surgical outcomes are functionally and aesthetically acceptable, psychological sequelae may persist.

Further documentation of such cases is essential. Efforts should be directed toward developing standardized, multidisciplinary management protocols combining surgical and psychological care to optimize long-term outcomes in this vulnerable population.