Hence, similar to other complex bacterial communities and the intestinal microflora [16] and the bacterial vaginosis microflora [6, 7] in particular, much Epacadostat of the bacterial diversity of the neovaginal microflora – consisting of 8.6 cultivable Citarinostat mouse species on average – remains uncharacterized through culture techniques. Still, using culture, twelve possibly novel species, designated TSW Genotypes A to L, were detected. Specific assays were applied to detect fungal species in the neovagina, as well as to assess the presence of the index species in bacterial vaginosis. While Candida albicans was

not seen on Gram stain, six women were found to harbour some fungal species, of which three remain unidentified. No firm conclusions can be drawn on the virtual absence of Candida albicans, however it may be acknowledged that in biological women Candida species are frequently encountered on the vaginal mucosa and that their colonisation of the vagina is stimulated

by estradiol. It is interesting to notice that the neovagina is colonized by largely the same intestinal species as the vagina in the absence of lactobacilli (some two thirds of transsexual women (64.0%) having evidence of colonisation with G. vaginalis, A. vaginae, or both, and over 80% of transsexual women harbouring M. curtisii) and thus that the same type of colonisation Emricasan supplier occurs, regardless the type of epithelium, vaginal mucosa of skin. The BVAB species 1 to 3, belonging PRKD3 to the phylum Clostridiales, and BVAB2 in particular, were found to be highly specific for BV in biological women [17, 18]. These were however not found in the neovaginal specimens, although it must be noted that the incidence

of these species in the vaginal microflora of female patients of our hospital was quite low as well (unpublished data). It is difficult to establish to what extent a bacterial vaginosis-like condition is present among these transsexual women. In a recent case report, a transsexual woman was diagnosed with bacterial vaginosis based on a Hay-Ison score of 2 (intermediate microflora) [19], although microscopy revealed numerous white blood cells and spirochaete-like organisms consistent with our observations. As a matter of fact, based on the criterion of a departure from a normal lactobacilli-dominated microflora, all patients in our study would qualify as having bacterial vaginosis-like microflora. We failed to document any association between specific bacteria and vaginal complaints – except for the unexplained and possibly spurious correlation between the presence of Mobiluncus and pain during sexual activity. It should be noted that also among biological women vaginitis symptoms are rarely associated with a single micro-organism.