Vaginal pH Measurement as a Strategy for the Early Diagnosis of Vulvovaginal Atrophy in the Development of Menopause

Objective: Most studies use clinical examination and evaluation of symptoms as subjective forms for the diagnosis of vaginal atrophy. Vaginal hormonal cytology and vaginal pH are objective forms commonly used, however, mainly for treatment control purposes. Despite the relevance of the early diagnosis of vaginal atrophy, we are not aware of studies that objectively or subjectively evaluate the evolution of the parameters with this intention. The aim of the study was to assess if the instruments most used in scientific studies for indication and follow-up of AVV therapy could be used for the early diagnosis of AVV. Methods: The sample consisted of 40 women, 21 in the menopausal/ premenopausal transition (Group 1) and 19 in the postmenopausal (Group 2), between 40 and 65 years old. Results: It was observed that the set of parameters evaluated, such as: symptoms, clinical examination, vaginal pH, cell maturation value and questionnaire, mainly when used in an associated way, suggest being efficient for the diagnosis of AVV. In general, the observed changes in pH measurement show a good association with cell cytology, which was very characteristic in the two experimental groups (pre and postmenopausal). In addition, pH also showed good association with clinical examination parameters and the main symptoms and signs of menopause. Conclusion: Finally, the results herein shown seems to be promising in relation to the use of vaginal pH measurement as a “tool” for the early diagnosis of AVV.

Contribution of Hormonal Cytology in Girls and Adolescents to Reproductive Health: A Traditional Technique Monitoring Recent Problems

Objective: To study the contribution of hormonal cytology in contemporary disturbances of fertility. Design: Over a 10-year period (2006-2015), 6,688 vaginal fornix cytologies of 2,350 patients were investigated. For a more detailed analysis, a 3-year period from 2013 to 2015 was chosen. Four hundred and fifty-two patients were investigated, many of them several times and for a period longer than the 3 years analyzed. Results: The main disorders examined and treated via a gentle hormonal medication support and life style corrections by a pediatric gynecologist were: pubertas praecox - thelarche praecox and early menarche; dysfunctional juvenile metrorrhagia; central and peripheral endocrine disorders; eating disorders - anorexia mentalis and bulimia; obesity; excessive sport activities; autoimmune disorders, and others. Normalization of the menstrual cycle was achieved while monitoring progress with a series of hormonal cytologies in a majority of patients. Conclusions: Hormonal cytology is a non-invasive and economical method, illustrating the direct effect of steroid on target cells. It contributes to reproductive health support by: (a) indicating the possible need and type of steroid therapy; (b) monitoring the normalization of cycle disturbances; (c) ruling out or indicating the need for more detailed steroid metabolism investigation. Thus, it represents a basic but valuable means of examination in child and adolescent gynecology.