Gonorrhoea and condyloma acuminata in a male transsexual.

The relative frequency of surgical sex reassignment of the male transsexual has prompted questions as to 'her' susceptibility to infections with gonorrhoea and the symptomatology and management of this infection in such patients. We have been unable to find any previous record of such a case and for this reason the present report may be of interest. Case report A 25-year-old male transsexual had genital reconstructive surgery in April, 1972, in New York City, and came to the clinic on October 16, 1972, because of a 'vaginal' discharge and dysuria of 1 week's duration. She also complained of a number of painless lumps on the labia which she feared might be syphilitic. She worked as an ecdysiast (stripper) in a night club and formerly as a prostitute, but now only with selected clientele. Examination and management She appeared to be a beautiful female with soft, white, non-hairy skin, well-developed breasts (the result of silicone injections and oestrogen), male pattern pubic hair which she shaved regularly, and reconstructed external organs of female appearance. There was a purulent urethral discharge and a number of papules with digitating surfaces on the labia and in the vagina; the latter extended a good 2" in depth. A specimen of pus for smear and culture on Thayer-Martin medium was taken from the urethra. The smear showed presumed gonococci; the patient (who was sensitive to penicillin) was treated with 2 g. spectinomycin intramuscularly. The culture was overgrown with B. proteus. A blood test for syphilis was non-reactive. The condyloma acuminata were successfully treated with 20 per cent. podophyllin in tincture of benzoin. Comment In determining the sex of an individual, four anatomical criteria are used: chromosome complement, anatomy of the gonad, anatomy of the external genitalia, and anatomy of the internal genitalia (Jones, Money, and Meyer (1972). It is the practice to designate the sex of an individual according to the gonads, a male having testes, and a female ovaries. A male transsexual has a testis but aspires to and assumes the female sex and considers herself as a female in social behaviour. The individual has a consistent and persistent desire to live as a female and takes progressive steps to do so (Money and Gaskin, 1970-71). Our patient lived as a female for 5 years before her operation, and regarded herself as a female trapped within a male body. The true male transsexual exhibits many aspects …