In terms of reproductive problems, egg-binding is a fairly common problem experienced by female box turtles. This condition results when a pregnant female cannot pass an egg. She typically strains excessively against the obstruction. The egg may be oversized or there may be metabolic or other reasons for her inability to pass the egg without assistance. Radiographs (x-rays) are usually made to confirm that the female is, in fact, fertile with eggs. Then, hormone injections and sometimes aspiration of the egg's contents are necessary to expel the stubborn egg. Several other conditions are seen in reproductively active female box turtles. Metritis (infection of the uterus) and egg-yolk peritonitis (ruptured egg-yolk or yolks within the body cavity) are the most common.
During the mating season, male box turtles periodically protrude and rhythmically fan their penis. A turtle's copulatory organ is flower-shaped and purple, and may appear unusual or abnormal to those unfamiliar with box turtles. It is most often mistaken for prolapsed organ and may be treated as such by those unfamiliar with box turtle anatomy and mating habits.
Prolapses may occur in the uterus, intestine, urinary bladder or penis (paraphimosis). The last condition occurs if the engorged penis cannot be returned inside the body cavity due to small vent size or previous trauma to the enlarged organ. An anesthetic and skillful manipulation by an experienced reptile veterinarian are usually necessary to replace a prolapsed organ. Clumsy attempts by novices may permanently damage the involved organs.