A 3 years study of vaginal hormonal cytology at tertiary hospital

Background: Vaginal cytology is an efficient inexpensive and a rapid method for identifying diseases including establishing the hormonal condition of the patient. The Evaluation of the endocrinologic status of the female patient by means of the study of vaginal cells is actually one of the earliest diagnostic applications of clinical cytology. Though the vaginal cytologic characteristics of gynecologic patients have been studied throughout the world this subjected has received little attention. Vaginal cytology is useful for assessing ovarian function from puberty throughout the reproductive years, menopause and senium. Also it is used to estimate time of ovulation, to determine ovarian dysfunction, to assess placental function or dysfunction in obstetrics, to assist in selecting hormonal therapy and to follow hormonal treatment results. Aim and objectives: To ascertain the effective utilization of cost effective test of vaginal hormonal cytology as a supplement for costly biochemical hormonal estimation. A prospective study was undertaken with the following objectives: To study the normal hormonal patterns in females of different age groups and to study abnormal hormonal patterns in high risk pregnancies and in different clinical situations. Materials and methods: A prospective, hospital based study was done on vaginal smears obtained from One hundred and Sixty (160) patients, attending Gynecology and Obstetrics Out-patient department and few In-patients at Gandhi hospital, Secunderabad during the period of August 2004 to October 2006. The study group included randomly selected female patients of reproductive age groups (18 years to 35 years.);.with normal menstrual cycles; normal perimenopausal (36 years to 45 years.) and postmenopausal (above 45 years.) women, pregnant patients in the 1st, 2nd, 3rd trimesters and 1st stage of labour as well as post partum patients. The study group also included patients with primary infertility, menorrhagia, secondary oligomenorrhoea (scanty menstruation), threatened abortions, inevitable abortions, pre mature rupture of membranes, post maturity and patients with neoplastic lesion i.e. ovarian tumor. The material collected for the vaginal smear dried very rapidly during collection. Hence fixation was done within 30 sec. of spreading. The fixatives used were – 95% Ethanol or 80% Isopropyl Alcohol. Other fixatives used were ether / 95% alcohols; 100% methanol; Rapid fixative as cytospray; 2 to 10% carbowax in 95% ethanol (for mailing unstained smears). The stains used were Papanicolaou's stain and Giemsa stain. Results: Vaginal hormonal cytology is a useful diagnostic aid in the female reproductive process. It may also provide a key to more effective conception control, as well as improvement in the treatment of menstrual disorders, anovulation, and other underlying disorders. In the present Indian scenario with lack of adequate clinical history available to the pathologist, in a rural setup as well the urban conditions; vaginal hormonal study is still a low cost diagnostic and prognostic test procedure. Hence the present study emphasizes the utility of vaginal smear study even today compared to the costly biochemical parameters available in the market which is a financial burden to poor patients. Conclusion: Vaginal smear collected between 4-11 days and 12-16 days of the normal menstrual cycle showed scattered intermediate and superficial cells. Vaginal smears collected between 17-28 days of normal menstrual cycle showed, predominately intermediate cells with folding and crowding. The KPI peak is between 12-16 days. This is extreme midzone shift, with clusters of navicular cells in all the three trimesters, of pregnancy. First stage of labour could be suspected with identification of increase in the number of superficial cells, with marked decrease in the intermediate cell values.