This will sound harsh, but part of the problem is the current aversion to calling things like this mental illness. Let's be real, if you are not clinically dysphoric and you want to sexually mutilate yourself it's crazy. I think that it is medical malpractice to not try to help the mentally ill from self-harm. If an issue is in your mind, I think that needs to be addressed first. I understand that is a slippery slope.