[Reprinted from the American Gynecological and Obstetrical Journal 
for May, 1895.] 
A CURIOUS ANOMALY OF THE FEMALE GENITALIA 
WITH STRIKING RESEMBLANCE TO SOME OF THE 
EXTERNAL MALE ELEMENTS CONVERTED 
BY PLASTIC SURGERY INTO A WOMAN 
OF NORMAL APPEARANCE.* 
By W. A. H. Coop, M. D., Lawrenceburg, Tenn. 
About the first of last August in response to a call I visited Mrs. 
, aged twenty-four, and married about ten months. The mes- 
senger, her father, informed me that she had been ailing some three 
or four months; that it was her mother's opinion that her daughter 
was probably three or four months pregnant, and that she was not 
like other women, and on account of this last-mentioned condition 
being suspected, they were very apprehensive as they thought it 
would be impossible for her to be delivered of a baby, and therefore 
they had sought my advice in the matter. I found the patient in bed 
and with a temperature of 102° F., and with an expression of suffering 
on her countenance ; to be brief, she was suffering, apparently, many 
of the concomitants of uterine and ovarian irritation ; being very 
tender and sensitive over the hypogastrium and especially just above 
the pelvic brim and on either side of the pubis; and she had some of 
the reflex phenomena, such as irritable stomach, capricious appetite, 
constipation and morning sickness, and also pain in the summit of the 
head and frontal and intercostal neuralgia. She had somewhat in- 
durated mammary glands, which she said had recently become en- 
larged, and the nipples were surrounded by a highly pigmented 
areola, but she was menstruating regularly. Upon examination of the 
external genitals, I found them of the most curious, unique and pe- 
culiar appearance. Looking from below, there appeared to be an 
analogue of the male scrotum however, without any appearance of a 
*Read before the first regular meeting of the Middle Tennessee Medical Society, 
held at Nashville, Tenn., November 20 and 27, 1894. 
Copyright, 1895, by J. D. Emmet and A. H. Buckmaster. 2 
JF. A. H. Coop, M. D. 
rhaphe or labial commissure, but without testicles or any other glandu- 
lar organs. Then passing forward to the front and reaching high up 
on the pubic bone, and extending backward about one third of the 
way to the anus was a faint but distinct outline of, what appeared to 
be, the widely spread nymphae, and projecting from between these 
apparent nymphse was the analogue of the male prepuce, three fourths 
of an inch in length and nearly as wide at its base and tapering toward 
the free extremity ; and consisting of very elastic and distensible tis- 
sues, and readily admitting of the index finger to the depth of nearly 
an inch and a half, at which distance the canal terminated in a narrow 
tract, which communicated with both the vagina and bladder, having 
a caliber equal to a No. 15 American measure. The prepuce and 
nympha-like bodies were covered with a highly pigmented epithelium, 
which coloring together with the outlines is shown in the photograph 
The mons veneris and the entire external abnormity were covered with 
an abundant growth of hair, except the prepuce and nympha-like 
bodies and a strip about three fourths of an inch in width extending 
back near the anus. At the upper part, and on the inside of the 
preputial appendix was a tubercle, which was much larger than the 
ordinary female clitoris, which it proved to be. The urine and men- 
strual fluid both flowed through this preputial orifice. Passing my 
finger into the rectum, I could detect a spheroid body at about the 
proper situation for the uterus, and after dilating the canal from the 
preputial orifice, by the introduction of a succession of male sounds 
through it, and with my finger in the rectum, I made out a canal 
reaching as high as the globular body before mentioned, being sepa- A Curious Anomaly of the Female Genitalia. 
3 
rated by a membranous wall from the rectum. I then passed a silver 
catheter into the bladder, whose entrance appeared to be as high 
behind the pubis as is usually found in the male. I then administered 
chloroform to the patient, and after passing some large sounds, 
as large as No. 20 American scale, I tried to dilate the passage 
further with my finger, but I found the canal so firm that I could do 
nothing in that way. Therefore, concluding that the prime cause of 
my patient's present indisposition was sexual excitement with unsatis- 
fied sexual desire, brought about by the nocturnal proximity of her 
fond husband, I gave orders that they occupy separate couches, and 
prescribed bromides, hyoscyamus, etc., and also a laxative. I told her 
that she needed a plastic surgical operation, and that I thought by 
such means, I could transmute her into a being that would have much 
more of the utility of a woman as well as having a more natural ap- 
pearance. She seemed very anxious for the change, and consequently 
on the nth ultimo, her health having greatly improved, with the kind 
and efficient assistance of Drs. R. H. Harvey, of Lawrenceburg, 
Tenn., and J. W. Maddin, Jr., of this city, I made the following plas- 
tic operation : 
Having shaved the parts well, together with the surrounding hairy 
parts, and washing with soap and water, followed by the antiseptic 
sublimate solution, I commenced by making an incision along the 
median line from the preputial appendage back to about an inch 
anterior to the anus, and going only well through the skin ; I then 
dissected the skin back from about half an inch in its greatest width 
to a very little space up near and in the prepuce. I then next passed 
a stout curved sound through the prepuce down to about the lower 
end of the line of incision I had made on the outside. I then made 
the tissues tight over the end of the sound, and cut down upon it into 
the canal and substituted a grooved director; I cut all the interven- 
ing tissues from below up through the preputial appendage, with a 
probe-pointed bistoury. Then Dr. Maddin and I made a digital and 
an ocular inspection of the underlying parts that had been hidden by 
the now divided structures. There was presented to view a most 
natural hymen, which gave way to a little force of the exploring index 
finger, revealing beyond it a capacious vaginal canal, and in the usual 
situation, the uterus. With shotted silkworm-gut sutures, passed 
through the margin of the detached skin, and then carrying the skin 
margin well down and in close apposition to the divided margin of the 
mucous membrane of the same side, I covered the entire cut surface 
with skin all the way around on either side, leaving the ends of the 4 
W. A. H. Coop, M. D. 
sutures projecting from the now labial commissure. The dressing 
consisted of ten-per-cent, iodoform gauze, applied next to the wound ; 
over this, sublimate gauze one to one thousand, kept in place with a 
T-bandage. The dressings were changed as often* as they became 
soiled, and the urine was drawn off with a male silver catheter ; as 
there appeared to be a hypospadias, it proved to be the most con- 
venient instrument for this purpose. The result of the operation has 
been all that could have been desired ; and the patient's external 
genitalia have a most natural appearance, provided, a very close in- 
spection is not made. Some of the present differences from the nor- 
mal, as seen by close inspection, are the nymphae, which were once 
the preputial appendage, and which are now somewhat more promi- 
nent than is usually the case, situated at the upper part of the labial 
commissure, and terminating or lost in the labia majora about an inch 
below the somewhat enlarged clitoris, which is covered with a very 
natural-looking hood. The hood is made up of the united upper con- 
tinuous ends of the newly made nymphse. Then again, in front of 
and somewhat within the ostium vaginae, is the entrance of a canal 
which passes upward and immediately in front of the vagina, and 
readily admits the index finger to a depth of nearly an inch and a 
half, where it terminates in the urethra proper, and is separated from 
the vagina by a membranous partition. The entrance to the bladder 
itself seems to be quite as high as it is usually in the male. The skin 
which was turned into the labial commissure is already converted, 
apparently, into mucous membrane, and there is scarcely a perceptible 
cicatrix to denote the former junction of skin and mucous membrane. 
The vagina itself is apparently more capacious than vaginas that have 
not been subjected to the wars of Venus. 
March 7, 1895.-I saw the above patient on the street four days 
ago and she said that her health was excellent; indeed she looked as 
though she had increased much in flesh. She and her husband both 
express themselves as being highly pleased with the results of the 
operation.