Erotic imagery and self-castration in transvestism/transsexualism: a case report.

After nearly 30 years of marriage, a 51-year-old man castrated himself in order to fulfill a long-standing fantasy of being a girl. There was a prior history of cross-dressing since childhood, and a reversed erotic role imagery during coitus. There was no history of schizophrenia or psychotic depression. Pair bonding with the wife was very strong. It led the patient to elect low-dose maintenance on androgen so as to permit some degree of continued marital sex. Otherwise the patient would have preferred estrogenization and, perhaps, eventual sex reassignment. The rehabilitative program as a transvestite man has continued for 3 years.