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Niggli S, Bausch K, Mijuskovic B, Nuñez DG, Vosshenrich J, Schaefer DJ, Seifert HH, Feicke A. Bartholin gland cyst in a transgender male: case report of a rare occurrence. Transl Androl Urol 2020; 9:1773-1777. [PMID: 32944538 PMCID: PMC7475659 DOI: 10.21037/tau-20-733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This case report highlights the importance of a wide differential diagnosis in transgender patients. A 77-year-old transgender (female-to-male) with recurrent urinary tract infections (UTI) and obstructive voiding difficulties presented with a perineal cyst. Further examinations, including computed tomography (CT) and puncture, revealed that the patient had a symptomatic Bartholin gland cyst, a phenomenon that normally only affects women. In his gender confirmation surgery (GCS) 30 years before, the patient’s female labia minora and Bartholin glands were used to lengthen the urethra for the phalloplasty. This explains the unusual location and the prolonged time to the correct diagnose. We decided to perform an incision of the fluid collection from perineal. A follow-up sonography after one month revealed a remaining cyst size of 6 mL, which was assumed to be residual fluid or newly produced liquid; however, the patient has not had any UTIs since the incision of the cyst. Our case seems to be the first description of a symptomatic Bartholin gland cyst in a trans man. This stresses the importance of an expanded understanding of sex/gender concepts, and underlines one of the many possible diagnostic pitfalls when treating trans people.
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Affiliation(s)
- Salome Niggli
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Kathrin Bausch
- Medical Faculty, University of Basel, Basel, Switzerland.,Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Barbara Mijuskovic
- Medical Faculty, University of Basel, Basel, Switzerland.,Center for Gender Variance, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - David Garcia Nuñez
- Medical Faculty, University of Basel, Basel, Switzerland.,Center for Gender Variance, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Dirk Johannes Schaefer
- Medical Faculty, University of Basel, Basel, Switzerland.,Center for Gender Variance, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Hans Helge Seifert
- Medical Faculty, University of Basel, Basel, Switzerland.,Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Antje Feicke
- Medical Faculty, University of Basel, Basel, Switzerland.,Department of Urology, University Hospital Basel, Basel, Switzerland.,Center for Gender Variance, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
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Abstract
About 20% of trans men do not achieve cisgender male frequencies (F0≤131 Hz) after gender-affirming hormone treatment (GAHT) with testosterone. The surgical procedure Isshiki thyroplasty type III (TPIII) is described to lower F0, but data on this technique in trans men are lacking. In this study, 8 trans men, unsatisfied with their voice after a minimum of 12 months of GAHT, underwent TPIII to lower F0 at the Department of Head and Neck Surgery at Ghent University Hospital. TPIII was performed by 1 surgeon using the same method each time. Pre- and postoperatively, an acoustic evaluation of the voice took place. The F0 dropped significantly from the preoperative mean of (154.60 ± 12.29) Hz to the postoperative mean of (105.37 ± 10.52) Hz (t = 9.821, P < .001). TPIII is an effective method for lowering the F0 in trans men who are not satisfied with their voice after long-term GAHT.
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Affiliation(s)
- Charlotte Bultynck
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Marjan Cosyns
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Guy T'Sjoen
- Centre for Sexology and Gender, Ghent University Hospital, Belgium.,Department of Endocrinology, Ghent University Hospital, Belgium
| | - John Van Borsel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Katrien Bonte
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
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Abstract
INTRODUCTION In the UK, funding for a bilateral mastectomy (BLM) and associated chest recontouring for female-to-male transsexuals (trans men) has been rejected by some funding authorities on a number of unsustainable grounds. METHODS As funding is increasingly an important area for both surgeons and referrers, we undertook a review of the small amount of literature pertaining to this issue and considered it in light of our clinical experience of this group. FINDINGS The literature showed that BLM is necessary for trans men to live safely and effectively in their reassigned gender role, and further that it acts as a prophylaxis against distress, ameliorates extant distress as well as providing improved quality of life and global functioning for this patient group.
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Affiliation(s)
- C Richards
- West London Mental Health NHS Trust Gender Identity Clinic, London, UK.
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