A forty-one-year-old white married man, the father of four children, had been a transvestite since the age of ten. After his mother's death when he was twelve, he slept in the same bed with his father until the father's remarriage five years later. The patient left home at this time and his pruritis began. It was markedly relieved whenever he engaged in transvestitism. After marriage in his early twenties, he noted that his itching became much worse during each of his wife's pregnancies. Finally, for the past three years he has worn only female clothes. In 1956 he had an emasculation operation.

His history illustrates castration anxiety with anal displacement, homosexuality, masochism, the wish to be a woman, and the wish to have children (possibly by hermaphroditic means); all contributed to his symptoms.