Microscopic examination of the vaginal smear

Examination of the vaginal smear for microflora is a laboratory study based on the evaluation of biological material under a light microscope. This is one of the main methods to assess the presence and nature of the inflammatory process in the genitals.

Microscopy allows us to evaluate:

• The nature of the vaginal microflora;
• Presence / absence of inflammatory process;
• Severity of the inflammatory process;
• Localization;
• The presence of a number of pathogens in the smear (causative agent or indirect signs of the presence of a specific pathogen).

The following indicators are evaluated during the examination:

Flat epithelial cells - Cells that line the inside of the vagina and cervix. Normally, the amount of epithelium in the smear depends on the phase of a woman's menstrual cycle, hormonal status, and should be interpreted according to these data. The presence of a large amount of flat epithelium in the smear may indicate an inflammatory process (vaginitis - inflammation of the vagina, cervicitis - inflammation of the cervix, urethritis - inflammation of the urethra), the absence of epithelium in the smear indicates hormonal disorders (female sex hormones).

Leukocytes - Cells that ensure the elimination of pathogens. A small number of leukocytes are allowed in the smear - no more than 10 leukocytes in the vagina and no more than 30 leukocytes in the cervical canal. Elevated leukocyte count in the smear indicates possible inflammation (vaginitis - inflammation of the vagina, cervicitis - inflammation of the cervical canal). It should be noted that the number of leukocytes usually varies according to the day of the menstrual cycle, so this should be taken into account when interpreting the results.

Erythrocytes - Red blood cells. Normally no erythrocytes are found in the smear.

Gram-positive sticks (Doderlein sticks - lactobacilli; "vaginal" sticks) - Lactobacilli, which form the basis of the normal microflora of the vagina. Usually, the smear contains a large number of such sticks. Decreased lactobacilli count is one of the signs of bacterial vaginosis.

Mucus Is a product of the glands of the vagina and cervix. Usually, the smear contains a small amount of mucus.

Spectrum of identified pathogens: Trichomonas vaginalis - the causative agent of urogenital trichomoniasis; Candida albicans - yeast-like fungus, etiological factor of vulvovaginal candidiasis, microscopy reveals fungal pseudomycelium; Extracellular diplococci; "Key cells" (Gardnerrella vaginalis - the cause of bacterial vaginosis), etc.

Based on the ratio of the number of lactobacilli and coccal flora, the degree of vaginal cleanliness is determined, allowing for the need for screening for primary screening and further examination of the woman.

Examination of the vaginal smear during pregnancy

Changes in the body's hormonal background (hyperestrogenism) and immune status (inhibition) during pregnancy significantly increase the risk of various inflammatory diseases of the vagina. The presence of an inflammatory process (in the cervix, vagina, external genitalia) endangers pregnancy, and can lead to termination of pregnancy, premature birth, and infection of the baby during childbirth. Interpretation of flora smear during pregnancy is carried out according to the same parameters as in non-pregnant women, however, it is necessary to take into account the change in the number of leukocytes - an increase of 15-20 in the field of vision and an increase in the number of flat epithelial cells.

When should a microscopic examination of a vaginal smear be performed?

• The presence of symptoms of inflammation related to the genitourinary system;
• Prophylactic examinations;
• Pregnancy;
• Monitoring the effectiveness of treatment;
• Monitoring the state of the microflora while taking antibiotics;
• Hormonal and immunosuppressive therapy.

How to prepare for the test?

Before taking smear:

• Refrain from urinating for three hours.
• Abstain from sexual intercourse for three days.
• Do not take antibacterial, antifungal medications for 14 days.
• Refrain from using vaginal suppositories, ointments, tampons for three days.
• The optimal time for sampling clinical material is from the 10th to the 20th day of the menstrual cycle.
• Material should not be taken during menstruation (only after three days).
• Material is taken by a gynecologist no earlier than 24 hours before the smear examination.
• No urogenital material is taken in the laboratory center (research is conducted only on the brought material).

Research material

Vaginal (vaginal) smear

Possible interpretation of the results

• In the smear big amount Flat epithelium The presence may indicate an inflammatory process (vaginitis, cervicitis, urethritis), smear of the epithelium Absence Indicates hormonal disorders (deficiency of female sex hormones).
• In the smear Increased leukocyte content Indicates possible inflammation (vaginitis - inflammation of the vagina, cervicitis - inflammation of the cervical canal).
• Reducing the number of lactobacilli It is one of the signs of bacterial vaginosis.
• The results obtained may indicate Pathogens Absence / existence of growth;

Will be determined Vaginal cleanliness:

I degree: The smear contains a large number of dodderlein sticks (lactobacilli), a small amount of flat epithelium. Completely healthy women are characterized by 1 degree of vaginal cleanliness.

II degree. A small amount of cocci is established in the smear, although Doderlein sticks predominate. Grade II vaginal cleanliness is not a sign of illness and is observed in many healthy women.

III degree: The smear contains a small number of dodderlein sticks, cocci predominate, and an increased number of leukocytes (more than 10 in the field of view) is noted. Grade III vaginal cleanliness is unfavorable and indicates the presence of inflammatory disease.

IV degree. The smear contains virtually no dodderlein sticks, contains large amounts of cocci and leukocytes. Grade IV vaginal cleanliness indicates bacterial vaginosis (inflammatory disease of the vagina with disappearance of normal microflora).

Resources

https://spravochnik.synevo.ua/ru/cytologia/mazok-na-mikrofloru.html