The criteria for assessing the state of the vagina

Assessment of the degree of proliferation of the vaginal epithelium

The first degree of proliferation (N-1)

In smears dominated by intermediate cells (to 90 %), can detect cell surface (to 10%) with large nuclei and basophilic cytoplasm, and a small amount of white blood cells. Swabs of this type occur in the first days of a normal menstrual cycle.

The second degree of proliferation (P-2)

Swabs of this type can be observed in the early follicular phase of the normal menstrual cycle.

The third degree of proliferation (P-3)

The third degree of proliferation (P-3) typical for the average follicular phase of the normal cycle.

The fourth degree of proliferation (P-4)

Swabs of this type often characteristic of the period of ovulation, but can also occur during the period of 11 until the 14th day of a normal menstrual cycle (late follicular phase).

Fifth degree of proliferation (II-5)

The smears are found only superficial cells of large size with clear contours, which are located separately. EI varies from 70 to 100%, KI -from 80 to 100%. Swabs of this type under normal menstrual cycle are not met. Their appearance indicates excessive estrogen stimulation. They often occur during periods of delay menstruation in patients, suffering from dysfunctional uterine bleeding, as well as in hormone producing tumors of the ovary.

Assessment of the luteal (progesterone) stimulation of the vaginal epithelium

First degree luteal stimulation (L-1)

Smears of type A-1 are characteristic of the early luteal phase. Smears become cloudy, darken. The edges of the flat surface of cells as a result of the influence of progesterone twist. Gradually the number of superficial cells decreases, and intermediate - increases. EI and CI 60-50 to ponyzhayutsya %.

Second degree luteal stimulation (L-2)

In the normal menstrual cycle strokes of type A-2 are observed in the middle of the luteal phase. The number of intermediate cells continues to increase, and surface - reduced. Stained cells predominantly basophilic tone, which leads to a significant reduction in EI and CI. Cells are arranged in small groups and clusters.

Third degree luteal stimulation (L-3)

In smears found layers of small intermediate cells without precise contours, sometimes a significant amount of white blood cells. Background dark smear. Swabs of this type indicate a massive desquamation of epithelial cells of the vagina and observed during the period from 24 until the 28th day of the normal menstrual cycle (late luteal phase).

In the normal menstrual cycle can occur strokes inflammatory and cytolytic types, the interpretation of which is often difficult.

Smears inflammatory type characterized by the presence of epithelial cells from different layers of the vaginal mucosa due to the violation of its integrity in the inflammatory process, and a large number of leukocytes, covering the entire field of view of the microscope. Bakteryalnaya flora kokkovaya. Identify the hormones in this type of smear is not possible.

Against the background of the detritus from the scraps of the cytoplasm and separately lying naked nuclei disrupted cells revealed a large number of rods Dederleyna, contributing to melting (cytolysis) intermediate cells; superficial and parabasal cells are not subjected to cytolysis. Pap smears of the type match in the luteal phase of the menstrual cycle, with moderate saturation hormone. For a quantitative analysis of an antibiotic is necessary prior, inhibits the growth of sticks Dederleyna. Cytolysis disappears within 10-15 days, then count the number of cells in a smear.

Assessment of the degree of atrophy of the vaginal epithelium

Normally, in the lives of women of reproductive age cells, characterized by atrophy of the vaginal epithelium, except for the period of postpartum amenorrhea, not found. The degree of atrophy determined by the number of cells from the deeper layers of the epithelium.

The first degree of vaginal atrophy (A-1)

In smears detected mainly in the intermediate cell surface and to the individual 10 % parabasal. These strokes often occur in the first years after menopause and secondary amenorrhea. Because of the presence of all types of epithelial cells they are called mixed-type strokes.

The second degree of vaginal atrophy (A-2)

The second degree of atrophy (A-2) characterized by a predominance of parabasal cells in smears, and the absence of surface. The number of intermediate cells ranges from 0 to 50 %. The number of leukocytes may be different.

The third degree of vaginal atrophy (A-3)

In smears found exclusively parabasal cells and white blood cells of the lower layers. Strokes occur when this type of primary amenorrhea, and many years after menopause.

Assessment of androgenic effects on the vaginal epithelium

Androgenic effects cause changes in vaginal epithelium, similar to the third degree of atrophy (A-3), maturation index 100/0/0.

Smears androgenic type rare, mainly in hormone producing tumors of the ovaries or adrenal glands, accompanied by severe masculinization of the female organism.

When mild androgenic effect of smears dominated by intermediate cells, superficial and parabasal - in a small amount or no (IS = 0-10 / 85 / 5-15). The cells are stained pale blue-green hues, CI and EI often not detected. This type of smear is observed in diseases of the ovaries or adrenal glands, accompanied by overproduction of androgens (congenital adrenal hyperplasia, Stein-Leventhal syndrome).