Penile strangulation is a surgical emergency with significant morbidity and potential mortality. It is often associated with psychiatric disorders; objects such as metal rings, plastic bottles, and rubber bands are commonly used. The San Francisco Office of the Chief Medical Examiner was presented with a 50-year-old transgender female decedent with a medical history of psychiatric and substance use disorders. Autopsy revealed external genitalia entrapped by a plastic bottle encircling the penile shaft at the base, causing severe edema and skin blebs of the penile shaft and glans, and evidence of urinary obstruction. We describe the accidental death of an adult transgender female decedent due to penile strangulation, which ultimately led to acute renal failure and death.
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