To describe the sex and age distribution of sputum submission and smear positivity in the Western Cape Province of South Africa. Laboratory registers of the South African Institute of Medical Research were examined retrospectively for the year 1999. Male tuberculosis (TB) suspects outnumbered females by 1.45:1, whereas amongst confirmed TB cases the ratio was 2.08:1. The odds ratio (OR) for smear positivity amongst males and females was 1.544. The proportion of male sputum positives significantly exceeded the proportion of males in the general population, as measured by the 1996 census. Not only did the number of male TB suspects and confirmed cases exceed that of females in absolute terms, but the proportion of male suspects proving smear-positive exceeded that of females. The age by sex distribution of new smear-positive patients followed the trend reported in recent literature. The gendered incidence of tuberculosis identified from this census is consistent with that of other developing countries. However, the smaller proportion of female TB suspects proving smear-positive suggests a higher index of suspicion in females and/or longer delays prior to care seeking amongst males.