PHYSIOLOGY OF THE VAGINA

Sri Kadarsih Soejono Bagian Ilmu Faal

Both proliferation and maturation of the vaginal epithelium are influenced by estrogen and progesteron

Three types of vaginal cells are exfoliated:

1. mature superficial cell which are squamous epithelial cells with pyknotic nuclei 2. intermediate cells, which relatively mature squamous epithelial cells whith vesicular, non pyknotic nuclei 3. para basal cells, which are thick , small, round, immature cells, with large vesicular nuclei

Para basal cells predominate before puberty, post menopause, and women with estrogen-deficient forms of amenorrhea

When ovarium estrogen secretion is low in the early follicular phase, the vaginal epithelium is thin and pale

and
As estrogen levels increase in the follicular phase, there is an increase in the number of cells, the thickness of the epithelium, and the number of cornified superficial cells

Under the influence of progesterone during the luteal phase, the percentage of cornified cells decreases
While the number precornified intermediate cells increases, and there are increased numbers of polymorphonuclear leukocytes and increased cellular debris and clumping of shed cells

Thus, the ratio among the various desquamated vaginal cell obtained by fixing a scraping from the upper third of the lateral vaginal wall on a microscope slide, can be used to evaluate estrogen effect This ratio has been termed the maturation index

Cervix and cervical mucus

Under the influence of estrogen, cyclic channges occur in the diameter of the external cervical os, the dimension of the external cervical canal, the vascularity of cervical tissues, and the amount and biophysical properties of cervical mucus

During the follicular phase, there is a progressive increase in cervical vasculariy congestion and edema, as well as in the secretion of cervical mucus

The external cervical os opens to a diameter of 3 mm at ovulation, and then decreases to 1 mm

Under the influence of increasing levels of estrogen, several changes in cervical mucus occur
1. a 10- to 30- fold increase in the amount of cervical mucus 2. the elasticity of the mucus (spinnbarkeit) increases 3. just before ovulation, palm leaf arborization (ferning) become prominent 4. the pH of the mucus increases to about 8.0 at midcycle

This ferning is result of the increased sodium chloride concentration in the cervical mucus induce by rising levels estrogen

and
Under the influence of progesterone during the luteal phase, :
1. cervical mucus thicken 2. less watery 3. loses its elastisity and ability to fern

These charateristics of cervical mucus can be used clinically to help evaluate the stage of the menstrual cycle, and to help a woman time her ovulation (the Billing method)

This mucus can indicate whether you are fertile or infertile by its sensation and appearance It is produce by the cervix , which is the part of the uterus that joins with the vagina, and which is under the control of the reproductive hormones

Scientific research has shown not only does the mucus signal the fertile state, it also appears to be essential if conception is to take place For without the mucus, sperm transport is impeded and the sperm cells die quickly in the acid environment of the vagina