Features of the colpocytological state and biocenosis of the vagina in menopausal women with atrophic vaginitis

Abstract

The objective: to study and evaluate the colpocytological state of the mucous membrane and the biocenosis of the vagina in women with atrophic vaginitis (AV) before CO2 laser therapy. Materials and methods. A prospective clinical and statistical examination of 160 patients with AV was conducted. The main group was formed from 55 women of menopausal age with clinical manifestations of AV, who were treated only by the therapy with CO2 laser. The comparison group included 40 women of menopausal age who had for the correction of AB manifestations CO2 laser therapy in combination with local hormonal therapy – suppositories which contain 0.5 mg of estriol. The control group included 65 women of menopausal age who were treated with the therapy with the local application of suppositories with 0.5 mg of estriol once a day. The standard hormonal colpocytology was performed in all the women to assess the colpocytological state of the vaginal mucosa. Diagnostic test strips were used to determine the condition of the vagine (pH). In the case of a shift in the pH of the vaginal contents ≥ 4.4, the degree of vaginal purity and the number of leukocytes were studied using a microscopic examination. An amine test was performed to determine the presence of bacterial vaginosis in patients with AB. The microbiological study was performed using the “Femoflor-16” method. Results. The hypoestrogenic and atrophic types of smears were found in all 160 (100.0 %) women. The inflammatory type of colpocytological smear was determined in 116 (72.5 %) patients, cytolytic type – in 14 (8.6 %), mixed type of vaginal smears – in 30 (18.6 %) persons. In 126 (78.6 %) women, the pH index shifted to the alkaline side and ranged from 4.9 to 5.6, and the average value was 5.2±0.31. The bacterioscopic analysis of vaginal discharges indicates that in 83 (65.9 %) women with pathological pH values, the third degree of purity of the vaginal smear according to Herlin was found. In every third of women – 37 (29.4 %) – the presence of Candida fungi was determined. A significant decrease in the number of Lactobacillus spp. was established, a sufficient number of which was found in 9 (10.8 %) of the examined women. Facultative anaerobic microorganisms were found in 34 (40.6 %) women with AB. Obligate anaerobic microflora – Gardnerella vaginalis in combination with Prevotella bivia and Porphyromonas spp., which was found in 23 (27.7 %) women, was in the first place among the detected microorganisms; Mobiluncus spp. in association with Corynebacterium spp. were in the second place in prevalence, and were determined in 18 (21.7 %) persons, in third place – Atopobium vaginae, which was diagnosed in 10 (12.0 %) of the examined women. A qualitative analysis of the culture study results demonstrates a high level of cultivation of facultative anaerobic and obligate anaerobic microorganisms in women with AB, the quantitative value of which reached lg 3.1 – lg 3.9 CFU/ml and lg 3.4 – lg 4.7 CFU/ ml, respectively. Conclusions. A one hundred percent predominance of hypoestrogenic and atrophic types of colpocytological smears was established in women with atrophic vaginitis. The frequency of detection of inflammatory, cytolytic and mixed types of colpocytological smears was 116 (72.5 %) cases, 14 (8.6 %) cases and 30 (18.6 %) cases, respectively. The initial examination of the vaginal pH demonstrates a shift in the alkaline side of this indicator in 126 (78.6 %) women, which ranged from 4.9 to 5.6, and the average value was 5.2±0.31. Bacterioscopic analysis of vaginal discharges established that in 83 (65.9 %) women with pathological pH values there was the third degree of vaginal purity according to Herlin. A significant decrease in the number of lactobacilli Lactobacillus spp. (lg 2.1±0.21 CFU/ml) on the background of an increase in the level of obligate anaerobic microorganisms in the microflora – Gardnerela vaginalis in associations with Prevotella bivia+Porphyromonas spp (lg 4.7±0.38 CFU/ml) in combination with Mobiluncus spp. in association with Corynebacterium spp. (lg 4.0±0.35 CFU/ml), and Atopobium vaginea (lg 3.4±0.28 CFU/ml) were determined.