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Open Access Highly Accessed Research article

Microflora of the penile skin-lined neovagina of transsexual women

Steven Weyers1*, Hans Verstraelen1, Jan Gerris1, Stan Monstrey2, Guido dos Santos Lopes Santiago3, Bart Saerens3, Ellen De Backer3, Geert Claeys3, Mario Vaneechoutte4 and Rita Verhelst4

Author Affiliations

1 Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium

2 Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium

3 Department of Clinical Chemistry, Microbiology & Immunology, Ghent University Hospital, Ghent, Belgium

4 Laboratory of Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, Ghent University Hospital, Ghent, Belgium

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BMC Microbiology 2009, 9:102  doi:10.1186/1471-2180-9-102

Published: 20 May 2009

Abstract

Background

The microflora of the penile skin-lined neovagina in male-to-female transsexuals is a recently created microbial niche which thus far has been characterized only to a very limited extent. Yet the knowledge of this microflora can be considered as essential to the follow-up of transsexual women. The primary objective of this study was to map the neo-vaginal microflora in a group of 50 transsexual women for whom a neovagina was constructed by means of the inverted penile skin flap technique. Secondary objectives were to describe possible correlations of this microflora with multiple patients' characteristics, such as sexual orientation, the incidence of vaginal irritation and malodorous vaginal discharge.

Results

Based on Gram stain the majority of smears revealed a mixed microflora that had some similarity with bacterial vaginosis (BV) microflora and that contained various amounts of cocci, polymorphous Gram-negative and Gram-positive rods, often with fusiform and comma-shaped rods, and sometimes even with spirochetes. Candida cells were not seen in any of the smears.

On average 8.6 species were cultured per woman. The species most often found were: Staphylococcus epidermidis, Streptococcus anginosus group spp., Enterococcus faecalis, Corynebacterium sp., Mobiluncus curtisii and Bacteroides ureolyticus. Lactobacilli were found in only one of 30 women

There was no correlation between dilatation habits, having coitus, rinsing habits and malodorous vaginal discharge on the one hand and the presence of a particular species on the other. There was however a highly significant correlation between the presence of E. faecalis on the one hand and sexual orientation and coitus on the other (p = 0.003 and p = 0.027 respectively).

Respectively 82%, 58% and 30% of the samples showed an amplicon after amplification with M. curtisii, Atopobium vaginae and Gardnerella vaginalis primer sets.

Conclusion

Our study is the first to describe the microflora of the penile skin-lined neovagina of transsexual women. It reveals a mixed microflora of aerobe and anaerobe species usually found either on the skin, in the intestinal microflora or in a BV microflora.