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“Secondary Transsexualism”: A Case Report for a man who Wants to Become a nun Elisabetta Pascolo-Fabrici a , Federico Sandri a , Sofia Panarello a , Francesca Fiorindo a , Sanja Nastasich a , Sara Benvenuto a [a] University of Trieste, ITALY. e.pascolo@fmc.units.it Transsexualism is considered to be the extreme end of the spectrum of gender identity disorders. In clinical observation we know that there are two different psychological structures of transsexualism: The “primary” emerges early in the child development and is linked with a clear perception of gender dysphoria. The “secondary” is typically late in a person’s development and is often secondary to other psychopathologies. In particular it can be connected to psychosis, borderline disorder, some kinds of depression or schizophrenia. In this work we underline the most important considerations about this secondary transsexualism trying to define some guidelines for a correct approach with this kind of patients. It is not common to find these cases in the literature because of its rare incidence and the complexity of the treatment. We describe a case report of a 45 years old man with this particular symptomatology who wants to become a woman to take vows as a nun. We underline some themes clearly lined with a secondary transsexualism; the patient links his decision to become a woman with some episodes of his past life in particular the sensation of his “intrusive” penis and anus (the patient reports some tickling sensations during arousal). Some important considerations regard the patient's interpretation of being a man similar as his father and his decision to become a nun (as a symbol of virginity). The difference between primary and secondary transsexualism is not quite clear since some people have a psychiatric symptomatology that could confuse the common guidelines. For this reason it is important to give a clear definition of these aspects. This case can be read to facilitate other clinics to an easier interpretation of secondary transsexualism.