International Journal of Research and Reports in Gynaecology

Genitourinary Syndrome of Menopause (GSM)- Pap Test and Gram Findings

José Eleutério Junior *

Postgraduate Program in Pathology, Federal University of Ceará (UFC), Fortaleza, Brazil and Prof. Eleutério Laboratory, Fortaleza, Brazil.

Renata Mírian Nunes Eleutério

Prof. Eleutério Laboratory, Fortaleza, Brazil and Biomedicine Course - Christus University Center, Fortaleza, Brazil.

João Victor da Silva Bezerra

Postgraduate Program in Pathology, Federal University of Ceará (UFC), Fortaleza, Brazil.

Armanda do Carmo Ponce de Leão Lins

Postgraduate Program in Pathology, Federal University of Ceará (UFC), Fortaleza, Brazil.

Marina Helena da Silva Lopes

Postgraduate Program in Pathology, Federal University of Ceará (UFC), Fortaleza, Brazil.

Ana Katherinne Silveira Gonçalves

Department of Obstetrics and Gynecology, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.

*Author to whom correspondence should be addressed.

---

Abstract

The loss of ovarian function, prematurely or due to menopause, causes a decrease of the vaginal epithelium trophy. However, with the end of the menstrual cycle and the consequent hypoestrogenism, the epithelial thickness also decreases, with only the parabasal and basal layers remaining with low glycogen reserves.  A thinner epithelial thickness associated with a pH greater than 4.5 and a microbiota without protective bacteria (Lactobacillus sp) can lead to an inflammatory condition not necessarily related to the action of a pathogen but mainly the atrophy itself.  Atrophic vaginitis is often confused with genitourinary syndrome of menopause (GSM). Laboratory findings do not necessarily coincide with symptoms but could help in diagnosing. Examinations such as bacterioscopy of vaginal smear (Gram) and cytology (Pap test or cytology in liquid medium) have findings that may suggest a picture of intense hypoestrogenism. However, the clinical-laboratory correlation is essential.

Keywords: Genitourinary syndrome of menopause, vaginitis, papanicolaou test, cytology

---

---

---

References

Beard MK. Atrophic vaginitis. Can it be prevented as well as treated? Postgraduate Medicine 1992, 91:6, 257-260.

DOI: 10.1080/00325481.1992.11701327

Phillips NA, Bachmann GA. Genitourinary syndrome of menopause: common problem, effective treatments. Cleve Clin J Med. 2018;85:390–398.

DOI: 10.3949/ccjm.85a.15081

Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020;12(4): e7586.

DOI: 10.7759/cureus.7586.

Angelou K, Grigoriadis T, Diakosavvas M, et al. (April 08, 2020) The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus 12(4): e7586.

DOI 10.7759/cureus.7586.

Heller DS, Weiss G, Bittman S, Goldsmith L. Does a diagnosis of atrophic vaginitis on Papanicolaou test signify the presence of inflammation? Menopause. 2015;22(8): 814-5.

DOI: 10.1097/GME.0000000000000393.

Kurita T. Developmental origin of vaginal epithelium. Differentiation. 2010;80(2-3):99-105.

DOI: 10.1016/j.diff.2010.06.007. Epub 2010 Jul 17.

Godha K, Tucker KM, Biehl C, Archer DF, Mirkin S. Human vaginal pH and microbiota: an update. Gynecol Endocrinol. 2018 Jun;34(6):451-455.

DOI: 10.1080/09513590.2017.1407753. Epub 2017 Dec 22

Brizzolara S, Killeen J, Severino R. Vaginal pH and parabasal cells in postmenopausal women. Obstet Gynecol. 1999 Nov;94(5 Pt 1):700-3.

DOI: 10.1016/s0029-7844(99)00384-1.

Kim S, Seo H, Rahim MA, Lee S, Kim YS, Song HY. Changes in the microbiome of vaginal fluid after menopause in Korean women. Microbiol Biotechnol. 2021;31(1).

DOI: 10.4014/jmb.2106.06022

Wilbur DC, Nayar R. Bethesda 2014: improving on a paradigm shift. Cytopathology. 2015;26(6):339-42.

DOI: 10.1111/cyt.12300.

Solomon D, Nayar R (Eds). The Bethesda system for reporting cervical cytology. Definitions, criteria, and explanatory notes. 3rd Ed. New York: Springer; 2015.

Yakoushina TV, Medina IM, Hoda RS. "String of pearls" appearance of blue blobs in postmenopausal atrophy on ThinPrep Pap test. Diagn Cytopathol. 2009;37(10): 738-9.

DOI: 10.1002/dc.21008

Crothers BA, Booth CN, Darragh TM, Means MM, Souers RJ, Thomas N, Moriarty AT. Atrophic vaginitis: concordance and interpretation of slides in the College of American Pathologists Cervicovaginal Interlaboratory Comparison Program in Gynecologic Cytopathology. Arch Pathol Lab Med. 2012;136(11): 1332-8.

DOI: 10.5858/arpa.2011-0441-CP