Periodic vaginal smear

The epithelial cells of the vagina also change periodically with the influence of the ovarian cycle. Periodic vaginal smear observation cells can reflect the level of estrogen in the body, so as to understand the endocrine status, a rough understanding of the ovarian function status of menstrual disorders, but can not detect whether ovulation. Periodic vaginal smear examination process: use a cotton swab or scraper to scrape the specimen from the vaginal y@ sidewall. (The epithelium is sensitive to endocrine and inflammatory reaction is small), soaked cotton can be used for young girls and unmarried women. The rod is stretched into the vagina to take the specimen, and the cotton swab is wound up before being inserted into the vagina, and the labia is separated to prevent the cotton from falling off the vagina. Basic Information Specialist classification: gynecological examination classification: vaginal secretion examination Applicable gender: whether women are fasting: not fasting Tips: It is best to have no sexual intercourse within 1 day before taking the specimen, no vaginal washing, dressing, lavage and topical medicine. Normal value Vaginal exfoliated cells at various stages of a woman's life. In women's lifetime, with the establishment of ovarian function, the effects of exuberance and decline are divided into several stages, each stage of vaginal epithelial cells have different changes. 1. Adolescent women in the age of 13-17, the development of follicles gradually mature and lead to normal physiological changes, but the secretion system is not stable during adolescence, so there is no obvious periodic change in vaginal smear cells. 2. Sexual maturity After puberty, the ovary matures and the vaginal epithelium changes periodically with changes in ovarian hormone levels. (1) The menstrual period lasts for 3-7 days. A large number of red blood cells, mucus and neutrophils were seen in the smear. A cluster of endometrial cells can be seen the next day. After the estrogen secreted by the ovaries, the surface cells in the smear gradually increased. (2) Passing the 5th to 11th days of the later period. Follicular development, estrogen levels rise. In the smear, the cells were mainly keratinized, and the keratinocytes began to increase gradually. The performance is light to medium high. (3) Days 12-13 of the pre-ovulation cycle. Follicles mature and estrogen levels rise. In the smear, keratinocytes account for 30-50%, and mucus and vaginal bacteria increase. Neutrophil reduction. Performance is moderate. (4) On the 14th to 16th day of the ovulation cycle, the estrogen level is the highest. The smear is all superficial cells, and the keratinocytes account for more than 60%. They are scattered and arranged, and there are few white blood cells. There are a large number of vaginal bacilli, and the back is dull and clean. clear. Performance is highly influenced. (5) On the 16th to 24th day of the late stage of the wolf, the ovarian corpus luteum formed, the progesterone level increased, the keratinocytes in the smear gradually decreased and the integrated heap was taken, the edge was folded, the leukocytosis increased, and the surface bacilli decreased. (6) On the 25th to 28th day of the premenstrual cycle, the corpus luteum declined, and the levels of estrogen and progesterone decreased abruptly. The cells in the smear are piled up, the edges are creased and the cell boundaries are unclear. Mucus and neutrophils increased, see naked nuclei, cell necrosis debris and vaginal disintegration debris. 3. Menopause begins around the age of 40 and can be classified into three stages: premenopausal, menopausal and postmenopausal. Premenopausal smears may have estrogen levels that are not low or sometimes elevated, but do not change periodically. Postmenopausal ovarian function declines gradually, estrogen levels are low, due to the high atrophy of the vaginal epithelium, poor resistance, often accompanied by inflammation. The cells in the smear are mostly inner and outer cells, and the nucleus is deeply stained. See more neutrophils, macrophages and red blood cells. Inflammatory stimuli can also be seen in the proliferating and degenerating middle, superficial, and squamous metaplastic cells. Clinical significance Abnormal results Vaginal epithelium is directly affected by ovarian endocrine, and its maturity is positively correlated with this human hormone level in the body. When the level of estrogen is high, there are more keratinocytes in the smear, and the nucleus is densely stained; when the level of estrogen is low, the smear appears small, round or oval, and the nucleus is loose and blue-stained. Therefore, the function of the ovary can be evaluated based on changes in epithelial cells in the smear. (1) Estrogen levels and vaginal exfoliated cell morphology 1. Estrogen is extremely low and the vaginal epithelium shrinks and thins. The exfoliated cells are mainly composed of inner cells, and the nuclei are deeply stained, and there may be a few middle cells. Found in elderly and ovariectomized patients. 2. Estrogen is highly depressed. Vaginal epithelial atrophy is not serious. The outer layer is mainly composed of cells. It may be mixed with a few middle and superficial cells with more mucus. Seen in menopausal symptoms, postmenopausal and mild women with ovarian dysfunction. 3. The moderately low estrogen is dominated by the middle layer cells, which support the cells and fuse the surface cells smaller than normal. Seen in menopausal symptoms, older but not menopausal, young people with amenorrhea. 4. The estrogen is mildly low and the anterior keratinocytes are mainly obtuse. The staining is light and mixed with a few middle cells. This smear has an estrogen level regime that maintains the normal thickening of the vaginal epithelium, which is slightly lower than in the later stages of menstruation. 5. Estrogen slightly affects the cells to the surface layer, with the polygonal anterior cells as the main plus a few middle cells. This smear is seen in patients who have undergone or undergo low-dose estrogen therapy. 6. The moderate effect of estrogen is mainly keratinocytes, and there are 30-40% keratinocytes. Found in patients with rapid development of follicles or pre-ovulation, when receiving moderate amounts of estrogen. 7. Estrogen highly affects keratinocytes accounted for about 60%, almost no white blood cells in the smear, clear background, red and blue keratinocytes and keratinocytes appear very bright, seen in ovulation or receiving large doses of estrogen therapy When the patient. 8. Estrogen significantly affects keratinocytes for up to 60-70%. Or keratinocytes account for 90% of the old estrogen is too high, this smear can be seen in ovarian granulosa cell tumor, ovarian cell tumor, endometrial cystic hyperplasia, endometrial adenocarcinoma and uterine fibroids and other patients . People who need to be examined: patients with menstrual disorders. Precautions Contraindications before examination: It is best to have no sexual intercourse within 1 day before taking the specimen, no vaginal washing, dressing, lavage and topical medicine. Requirements for inspection: 1. The scraper, straw or cotton swab used in the specimen must be dry and clean. The speculum used can be wetted with physiological saline. 2, the specimens should be evenly applied to the clean glass slides, the thickness is moderate, such as too thin cells, the results are not reliable, too thick cells overlap, affect the inspection, do not apply back and forth when smearing, so as not to affect the cell morphology. 3. After the smear is made, it should be placed in 95% alcohol to fix the protein of the cells to prevent cell structure damage. The fixation time should not be shorter than 15mmn. The fixative should be filtered frequently to prevent contamination. 4, such as smear with blood, can be fixed with 1% glacial acetic acid alcohol for 3-5min (1ml of glacial acetic acid, 95% alcohol 99ml), and then moved to the general fixative. Inspection process Use a cotton swab or scraper to gently scrape the specimen from the upper side of the vagina (the epithelium is sensitive to endocrine, and the inflammatory response is small). For young girls and unmarried women, use a soaked cotton swab to extend the vagina and take the specimen. Wrap the cotton swab in front of the vagina and separate the labia to prevent the cotton from falling into the vagina. Not suitable for the crowd Inappropriate people: not yet known. Adverse reactions and risks No relevant information.

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