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Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina
Author(s) -
Grosse A.,
Grosse C.,
Lenggenhager D.,
Bode B.,
Camenisch U.,
Bode P.
Publication year - 2017
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12417
Subject(s) - medicine , vagina , squamous intraepithelial lesion , cytology , lesion , vaginoplasty , human papillomavirus , gynecology , pathology , dermatology , cervical intraepithelial neoplasia , cervical cancer , cancer , surgery
Objective The primary objective of this study was to describe the cytological findings of bowel and (penile) skin‐lined neovaginas in patients with gender dysphoria (GD) and individuals with a congenital or acquired absence of a natural vagina. The secondary objective was to correlate the cytological findings with clinical characteristics such as oestrogen replacement therapy (ERT). Methods A retrospective review of an institutional pathology archive over a 15‐year‐period was performed to identify cytological samples of neovaginal vaults. The medical and surgical records of the patients identified (n=20) were evaluated. Results Well‐preserved nucleated squamous cells were found in 70% (14/20) of patients. Neovaginal samples showing superficial, intermediate and parabasal cells plus Döderlein flora similar to normal cervical cytology were present in only 10% (2/20). Three samples (15%, 3/20) showed atypical squamous cells of undetermined significance (ASC‐US) that were all negative for high‐risk human papillomavirus (HR‐HPV) types, whereas one case was positive for low‐risk (LR) HPV. One patient (5%, 1/20) was diagnosed with an HR‐HPV‐positive high‐grade squamous intraepithelial lesion (HSIL), and one patient (5%, 1/20) had an HR‐ and LR‐HPV‐positive low‐grade squamous intraepithelial lesion (LSIL). The correlation between the presence of nucleated squamous cells and ERT was significant ( P =.032). Conclusion Cytological findings of the neovagina resemble normal cervical cytology with superficial, intermediate and parabasal cells as well as Döderlein bacilli in a minority of cases. Because precancerous lesions and invasive carcinoma may develop in the neovagina, patients with neovaginas should be subject to cancer screening programmes.