physiology of the vagina
TRANSCRIPT
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PHYSIOLOGY OF THE
VAGINA
Sri Kadarsih Soejono
Bagian Ilmu Faal
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Both proliferation and maturation of the
vaginal epithelium are influenced by
estrogen and progesteron
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Three types of vaginal cells are exfoliated:
1. mature superficial cellwhich are squamous
epithelial cells with pyknotic nuclei
2. intermediate cells, which relatively maturesquamous epithelial cells whith vesicular,
non pyknotic nuclei
3. para basal cells, which are thick , small, round,
immature cells, with large vesicular nuclei
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Para basal cells predominate before
puberty, post menopause, and women
with estrogen-deficient forms of
amenorrhea
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When ovarium estrogen secretion is low
in the early follicular phase, the vaginal
epithelium is thin and pale
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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
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Under the influence of progesterone duringthe luteal phase, the percentage of cornifiedcells decreases
While
the number precornified intermediate cellsincreases, and there are increased numbers
of polymorphonuclear leukocytes andincreased cellular debris and clumping ofshed cells
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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 microscopeslide, can be used to evaluate estrogen
effect
This ratio has been termed thematuration index
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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 andbiophysical properties of cervical mucus
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During the follicular phase, there is aprogressive increase in cervical vasculariy
congestion and edema, as well as in the
secretion of cervical mucus
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The external cervical os opens to adiameter of 3 mm at ovulation, and then
decreases to 1 mm
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Under the influence of increasing levels ofestrogen, several changes in cervicalmucus occur
1. a 10- to 30- fold increase in the amount ofcervical 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 8.0at midcycle
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This ferningis result of the increasedsodium chloride concentration in the
cervical mucus induce by rising levels
estrogen
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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
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These charateristics of cervical mucus canbe used clinically to help evaluate the
stage of the menstrual cycle, and to help a
woman time her ovulation (the Billingmethod)
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This mucus can indicate whether you arefertile 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 ofthe reproductive hormones
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Scientific research has shown not onlydoes 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 quicklyin the acid environment of the vagina