Colpositology study - Causes, symptoms and treatment. MF.
The method is based on the pronounced effect of steroid ovarian hormones on the target organs, which includes the epithelium of the vagina. As a result, cyclical changes of the epithelium( vaginal cycles) occur during the menstrual cycle, characterized by a different degree of maturation of the epithelial cells. Three types of cells are separated from the vaginal walls: parabasal - small, with a diameter of about 15-25 mm, with a round nucleus originating from the lower( germinative) layer, intermediate - larger ones, with a diameter of 25-30 μm and a vesicular nucleus with a diameter of about 9μm, originating from the middle layer of the vaginal epithelial cells, and the largest, the largest, with a diameter of about 6 μm, polygonal cells that can have either a vesicular or pycnotic nucleus( diameter less than 6 μm).In the latter case, the cells reflect the maximum degree of maturation of the vaginal epithelium, which is observed with an increase in the estrogen saturation of the organism.
Quantitative analysis of the ratio of cells in the smear and their morphological characteristics are the basis of hormonal cytodiagnostics.
For a cytological examination, the material is obtained by aspirating or gently touching the instrument to the side wall of the vagina( do not scrape the mucous membrane!): Only those cells that are free to separate from the vaginal mucosa should enter the smear. The material taken is transferred to a slide, fixed and colored. For coloring, the polychrome Schorr method( or its modification) is often used to differentiate cells into eosinophilic( red) and basophilic( blue), and monochrome methods( staining with hematoxylin and eosin or hematoxylin and fuchsin).
A stained smear is examined under a microscope and cells are counted( 200-300 cells, better from the center of the smear).When counting cells, three indicators( index) are determined.
1. IP( numerical index, maturity index) is the percentage of the three types of epithelial cells - parabasal, intermediate and superficial. It is recorded in the form of three numbers from left to right: a shift to the left signifies the appearance of parabasal cells, indicative of insufficient function of the ovaries, a shift to the right - an increase in the number of surface cells, which indicates a high estrogen saturation of the organism.
2. CI is the percentage of surface cells with pycnotic nuclei to the total number of cells in the smear. The higher the value of this index, the higher the estrogen saturation of the body.
3. EI - percentage ratio of eosinophilically stained surface cells to the total number of smear cells. Just like CI, it serves as an indicator of estrogenic effects. In norm, EI is always lower than CI, otherwise eosinophilia has a non-hormonal origin.
In addition to these indices, take into account the crowded cytoplasm of cells( three-point system), the location of cells - the presence of strata, or the index of crowding, which is the ratio of cells in clusters of 5 or more, to cells located separately. These two indicators characterize the progesterone effect.
In smears, there may be signs of inflammatory changes in which endocrinological treatment is not possible, and cytolysis to which intermediate cells are exposed as a result of the action of the Dederlein sticks.
On the study of vaginal smears, you can indirectly judge not only the ratio of estrogens and gestagens in the body, but also about hyperandrogenism. Androgenic types of smears are characterized by IC shifts to the left and the appearance of slightly larger, than parabasal, round cells, a clean background of the entire smear, a pale coloration of the cytoplasm( an atrophic androgenic smear).More often, the androgenic effect is combined with estrogenic, which is also manifested by a shift of the IC to the left, but less significant than in the first case, a decrease in the values of CI and EI, the curved edges of the intermediate cells( reminiscent of navicular ones in pregnancy), frequent cytolytic changes.
If it is not possible to conduct a colpositologic study( inflammatory changes in the walls of the vagina, abundant uterine bleeding), use an urocytogram. In this case, the smear is obtained from the urine sediment obtained by centrifugation. Staining and evaluation of smears are the same as those of vaginal.
Colpocytological parameters in the normal menstrual cycle( M ± t),%
| Study time( cycle days) | IS | CI | EI | ||
| Parabasal cells | Intermediate cells | Surface cells | |||
| 4-9 | Single in preparation or absent | 80.2 ± 7.9 | 19.9 ± 2.4 | 15, 3 ± 2,1 | 10,6 ± 1,9 |
| 10-13 | 0 | 60 ± 6.7 | 40 + 4.1 | 30 ± 3.6 | 25.5 + 4 |
| 14-15th( ovulation) | 0 | 15 ± 2.1 | 85 + 9.3 | 80.7 + 9.3 | 75.4 + 6 |
| 16-20 | 0 | 60.5 ± 6.2 | 39.5 + 5.3 | 30,8 + 3.9 | 25.6 ± 4.7 |
| 21-27 | 0 | 80 ± 9.3 | 20 +. 2.9 | 10.6 ± 2 | 8.8 ± 1.9 |