0 cm wide) had to be used in the remainder of women. Only in one patient insertion of a speculum was impossible due to almost complete obliteration of the vagina. Although this was not a study criterion and therefore not scored, a foul smell of the vagina was observed in most patients. The mean vaginal pH was 5.88 (SD = 0.49, range 5.0–7.0). There was no correlation between the vaginal pH and

complaints of irritation, dysuria or malodorous discharge. Gram stain The fifty neovaginal swab specimens were Gram stained. For six smears, one with numerous white blood cells, few bacteria were found. Forty-four smears revealed mixed microflora that had some similarity with bacterial vaginosis microflora and that contained various amounts of cocci, polymorphous Gram-negative and PERK modulator inhibitor Gram-positive rods, often RNA Synthesis inhibitor with fusiform and comma-shaped rods, and sometimes even with spirochetes (Figure 1). In five of these {Selleck Anti-diabetic Compound Library|Selleck Antidiabetic Compound Library|Selleck Anti-diabetic Compound Library|Selleck Antidiabetic Compound Library|Selleckchem Anti-diabetic Compound Library|Selleckchem Antidiabetic Compound Library|Selleckchem Anti-diabetic Compound Library|Selleckchem Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|buy Anti-diabetic Compound Library|Anti-diabetic Compound Library ic50|Anti-diabetic Compound Library price|Anti-diabetic Compound Library cost|Anti-diabetic Compound Library solubility dmso|Anti-diabetic Compound Library purchase|Anti-diabetic Compound Library manufacturer|Anti-diabetic Compound Library research buy|Anti-diabetic Compound Library order|Anti-diabetic Compound Library mouse|Anti-diabetic Compound Library chemical structure|Anti-diabetic Compound Library mw|Anti-diabetic Compound Library molecular weight|Anti-diabetic Compound Library datasheet|Anti-diabetic Compound Library supplier|Anti-diabetic Compound Library in vitro|Anti-diabetic Compound Library cell line|Anti-diabetic Compound Library concentration|Anti-diabetic Compound Library nmr|Anti-diabetic Compound Library in vivo|Anti-diabetic Compound Library clinical trial|Anti-diabetic Compound Library cell assay|Anti-diabetic Compound Library screening|Anti-diabetic Compound Library high throughput|buy Antidiabetic Compound Library|Antidiabetic Compound Library ic50|Antidiabetic Compound Library price|Antidiabetic Compound Library cost|Antidiabetic Compound Library solubility dmso|Antidiabetic Compound Library purchase|Antidiabetic Compound Library manufacturer|Antidiabetic Compound Library research buy|Antidiabetic Compound Library order|Antidiabetic Compound Library chemical structure|Antidiabetic Compound Library datasheet|Antidiabetic Compound Library supplier|Antidiabetic Compound Library in vitro|Antidiabetic Compound Library cell line|Antidiabetic Compound Library concentration|Antidiabetic Compound Library clinical trial|Antidiabetic Compound Library cell assay|Antidiabetic Compound Library screening|Antidiabetic Compound Library high throughput|Anti-diabetic Compound high throughput screening| smears white blood cells were seen. Candida cells were not seen in any of the smears. There was no correlation between malodorous vaginal discharge and painful dilation on one hand and the presence of leucocytes on Gram stain on the other hand. Figure 1 Microscopic image (1000×) of Gram-stained neovaginal smears illustrating

the observed diversity: various amounts of cocci (A), polymorphous Gram negative and Gram positive rods, often with fusiform (B) and comma-shaped rods (C), and sometimes even with spirochetes (D). Identification of cultured isolates from 30 transsexual women by tDNA-PCR and 16S rRNA gene sequencing Of the 582 isolates that were picked after

culture of the 30 neovaginal specimens on 5 different media, Sinomenine a total of 378 isolates could be identified by tDNA-PCR. A further 56 isolates could be identified after sequencing of the 16S rRNA gene. 79 different species and 12 possibly novel species (referred to as TSW Genotype A to L) were identified (Table 1). TSW Genotype B, I and K had more than 98% similarity to previously cultured isolates. All other genotypes had between 83% and 99% similarity with previously cloned sequences (Table 1). Table 1 Detailed composition of the neovaginal microflora of 30 swab samples, as determined by culture and tDNA-PCR based identification. Cultured species n Cultured species n Actinobacteria   Firmicutes   Actinobaculum massiliense 2 Anaerococcus hydrogenalis 1 Actinobaculum schaalii 1 Anaerococcus tetradius 1 Actinomyces meyeri 6 Anaerococcus vaginalis 3 Actinomyces neuii 2 Bacillus sp. 1 Actinomyces radingae 1 Clostridium perfingens 1 Actinomyces sp. 2 Enterococcus faecalis 13 Actinomyces turicensis 1 Enterococcus sp. 1 Actinomyces urogenitalis 2 Facklamia hominis 1 Arcanobacterium bernardiae 1 Finegoldia magna 7 Arcanobacterium pyogenes like 1 Lactobacillus casei 1 Atopobium vaginae 2 Peptoniphilus indolicus 6 Bifidobacterium bifidum 1 Peptoniphilus lacrimalis 6 Bifidobacterium longum 1 Peptoniphilus sp.