Envejecimiento del sistema urogenital y disfunción sexual femenina / Aging of the urogenital system and female sexual dysfunction

Resumen El sistema genitourinario presenta una serie de cambios micro y macroanatómicos desde el nacimiento, pasando por la pubertad, período reproductivo y por último con la menopausia, en la cual, se desarrolla un conjunto de síntomas sistémicos que incluyen los vasomotores, del sueño, cognitivos, del estado de ánimo y cambios sexuales, asociados a la presencia de disminución de la lubricación, estrechamiento y distensibilidad vaginal, atrofia vaginal, entre otros, que llevan a presentar una clínica de dispareunia, prurito, resequedad, además de síntomas urinarios. Su examinación conlleva la realización de una historia clínica, examen físico y ginecológico. Para confirmar los cambios se puede hacer una medición de pH y una citología para determinar un índice de maduración vaginal. Cuando estos síntomas se asocian a angustia y molestia se puede estar ante un caso de disfunción sexual, del cual se conocen factores de riesgo para su presencia como la edad como tal, problemas de pareja, estado de salud, autoestima, entre otros. Es por esto que a razón del tratamiento es importante hacer un abordaje interdisciplinario.

Abstract The genitourinary system presents a series of micro and macroanatomical changes from birth, through puberty, reproductive period and finally with menopause, in which a set of systemic symptoms are developed, including vasomotor, sleep, cognitive, mood and sexual changes, associated with the presence of decreased lubrication, narrowing and vaginal distensibility, vaginal atrophy, among others, leading to clinical symptoms of dyspareunia, pruritus, dryness, and urinary symptoms. Its examination involves the realization of a clinical history, physical and gynecological examination. To confirm the changes, a pH measurement can be made and a cytology to determine a vaginal maturation index. When these symptoms are associated with anguish and discomfort, there may be a case of sexual dysfunction, of which there are known risk factors for their presence such as age as such, couple problems, health status, self-esteem, among others. That is why, as to treatment, it is important to make an interdisciplinary approach.

Citología y análisis morfométrico de las células del epitelio vaginal durante el ciclo estral en ovejas de pelo (Ovis aries) / Citology and morphometric analysis of epithelial cells from the vagina of hair sheep ewes (Ovis aries) during their estrous cycle

La citología vaginal puede usarse para caracterizar estados del ciclo reproductivo de la hembra. Sin embargo, no ha sido validada en ovinos de pelo, y ofrece resultados inexactos debido a interpretaciones subjetivas. El objetivo del presente trabajo es tipificar las características morfológicas y morfométricas de las células epiteliales de la vagina durante el ciclo estral en ovinos de pelo. Cinco borregas Santa Cruz se sincronizaron con esponjas intravaginales. Desde el día del 1er celo posterior al retiro de la esponja y hasta el siguiente celo, se obtuvieron muestras diarias del epitelio vaginal de cada oveja, y se cuantificó el número de células parabasales, intermedias y superficiales, y se midió la longitud, perímetro y área de citoplasma y núcleo de cada una. Los resultados muestran que las células superficiales incrementan (P<0,05) durante el estro en comparación con el diestro. En contraste, el número de células parabasales e intermedias es mayor (P<0,05) durante el diestro que en el estro. Las células más grandes (36,11+/-0,38 µm) y núcleos más pequeños (8,46+/-0,12 µm) se encontraron durante el estro, independientemente del tipo de célula, mientras que citoplasmas más pequeños (26,72+/-0,11 µm) y núcleos más grandes (10,48+/-0,02 µm) se observaron durante el diestro. Se concluye que la morfología de las células epiteliales de la vagina de la oveja de pelo coincide con las variaciones encontradas en otras hembras, y que el tamaño de citoplasmas y núcleos presenta un patrón cíclico que puede utilizarse para determinar de manera objetiva la etapa del ciclo estral de la oveja.

Vaginal cytology can be used to characterize stages of the reproductive cycle of the female. However, it has not been validated in hair sheep, and generates inaccurate results due to subjective interpretations. Thus, the purpose of the present work is to typify morphologic and morphometric characteristics of the epithelial cells from the vagina during the estrous cycle of hair sheep. Five Saint Croix ewes were synchronized with intravaginal sponges. Day zero of the cycle was considered the day of first estrus after sponge withdrawal. From this day until next estrus, samples from the vaginal epithelium were obtained daily from each ewe. The number of basal, intermediate and superficial cells was quantified, and length, perimeter, and area from cytoplasm and nucleus were obtained. The results show that the number of superficial cells increase (P<0.05) during estrus and decrease during the rest of the cycle. In contrast, the number of basal and intermediate cells showed an inverse pattern. The largest cells (36.11+/-0.38 µm) and smallest nucleuses (8.46+/-0.12 µm) were present during estrus, regardless of the cell type, while the smallest cells (26.72+/-0.11 µm) and larger nucleuses (10.48+/-0.02 µm) were observed during diestrus. It was concluded that citology of the epithelial cells from the vagina of hair ewes is in accord with changes found in other female spices, and that cytoplasm and nucleus sizes display a cyclic pattern that might be used to objectively determine the specific estrous cycle phase of the ewes.

Citologia vaginal de preguiça-de-coleira (bradypus torquatus) / Vaginal cytology of maned sloth (bradypus torquatus)

As preguiças-de-coleira (Bradypus torquatus) são mamíferos arborícolas da família Bradypodidae. Podem ser encontradas nos trechos de Mata Atlântica do Brasil e a maior diversidade genética de suas populações ocorre em matas do sul da Bahia. A observação desses animais na natureza é muito difícil, pois passam a maior parte da vida escondidos no denso emaranhado das copas, por isso, dados sobre aspectos reprodutivos são escassos e não existem informações sobre ciclo estral dessa espécie. Este trabalho teve por objetivo identificar as células do epitélio vaginal da preguiça-de-coleira (Bradypus torquatus) como forma de viabilizar o uso dessa técnica para estudar as fases do ciclo estral desses animais. As amostras para citologia vaginal foram obtidas de quatro preguiças de coleira que habitavam áreas de Mata Atlântica do sul da Bahia. Após captura manual do animal, procedeu-se a coleta de material biológico, introduzindo uma escova ginecológica estéril, na comissura dorsal da vulva. Para cada amostra foram feitos dois esfregaços rotacionando a extremidade da escova sobre cada lâmina de vidro, fazendo-se em geral três impressões lineares. O esfregaço foi imediatamente corado pelo método Panótico rápido (Laborclin®). Nas preguiças BT033, BT065 e BT042 foi possível identificar respectivamente 30%, 33% e 7% de células parabasais (PB); 56%, 22% e 10% de células intermediárias pequenas (IP); 6%, 18% e 6% de células intermediárias grandes (IG); 2%, 13% e 24% de células superficiais nucleadas (SN); 6%, 14% e 53% de células superficiais anucleadas (SA). Na preguiça BT464 foi possível fazer duas coletas com intervalo de 13 meses. Os dados da primeira e segunda coleta foram, respectivamente: 6% e 17,5 de células PB, 5% e 25% de células IP, 11% e 15,5% de células IG, 8% e 19,5% de células SN e 70% e 22,5% de células SA. Enfatiza-se que as porcentagens de células do epitélio vaginal variaram entre indivíduos e também na mesma preguiça. Isto sugere que a citologia vaginal possa ser uma ferramenta de avaliação do ciclo estral em preguiça-de-coleira.

Maned sloths (Bradypus torquatus) are arboreal mammals of the family Bradypodidae. They can be only found in the Atlantic coast forest of Brazil and its most genetically diverse populations occur in forests of southern Bahia. The observation of these animals in the wild is very difficult as they spend most of their lifetime hidden in the dense forest canopy. Data on their reproductive aspects are scarce, and there is none information about their estrous cycle. This research aimed at identifying the vaginal epithelial cells of maned sloths (Bradypus torquatus) as a possible way to study the phases of the estrous cycle of this animal. The samples for vaginal cytology were obtained from four free ranging maned sloths living in a protected area of coastal forest in the South of Bahia. The sterile gynecological brush was inserted up to the necessary distance to reach the pelvic channel. For each sample two smears were made by rotating the tip of the brush onto each glass slide, producing in general three linear impressions. Staining was performed using rapid Panotic Kit (Laborclin®). Maned sloths BT033, BT065, and BT042 presented, respectively, 30%, 33%, and 7% of parabasal epithelial cells (PB); 56%, 22%, and 10% of small intermediate cells (IP); 6%, 18%, and 6% of large intermediate cells (IG); 2%, 13%, and 24% of superficial epithelial cell with a nucleus (SN); 6%, 14%, and 53% of anucleated superficial epithelial cell (AS). Two cell samples were collected for maned sloth BT464 with a 13 months interval. Cytological differences were observed between the two samples (1st and 2nd): 6% and 17,5% of PB cells, 5% and 25% of IP cells, 11% and 15,5% of IG cells, 8% and 19,5% of SN cells and 70% and 22,5% of AS cells, respectively. It’s interesting to remark that the percentage of vaginal epithelial cells varied among sloths and also for the same animal. This result suggests that vaginal cytology of maned sloth can be used as a tool to evaluate of estrous cycle.

Estudio comparativo entre las características citológicas de los epitelios nasal, faríngeo y vaginal en mujeres adultas jóvenes / Comparative study of cytological characteristics of the nasal, pharygeal and vaginal epithelium in young adult women

Determinar y comparar las características citológicas de los epitelios nasal, faríngeo y vaginal en mujeres adultas jóvenes. Estudio prospectivo y transversal de 35 mujeres no embarazadas, entre 18 y 35 años de edad, durante el período comprendido entre el 01 de enero al 01 de julio de 2004; que ingirieron o no anticonceptivos orales y a quienes se les estudiaron las citologías de los epitelios vaginal, faríngeo y nasal, según el porcentaje de índice de maduración de células exfoliadas y la cuantificación sérica de estrógeno y progesterona. En el Departamento de Obstetricia y Ginecología Hospital Chiquinquirá de Maracaibo, Estado Zulia. Se determinó que no existe diferencia significativa entre la celularidad de los epitelios estudiados. Se estableció que existe buena correlación entre las células superficiales e intermedias de los frotis de vagina, faringe y nariz durante las fases del ciclo menstrual, en todas las mujeres, aun en las que recibieron píldoras anticonceptivas. Los niveles de estrógenos y progesterona tuvieron concordancia con las fases del ciclo, con el porcentaje y tipo de células exfoliadas. Los resultados obtenidos demuestran que los epitelios nasales y faríngeos responden al influjo de hormonas ováricas similarmente como ocurre en la vagina y que estos métodos pueden ser aplicados en condiciones de difícil acceso a laboratorios hormonales o en pacientes vírgenes o con atresia/agenesia vaginal y niñas

To determine and compare the cytological characteristics of nasal, pharyngeal and vaginal epitheliums in young adult women. A prospective and transversal study of 35 non pregnant women of 18 to 35 years old during the period January 1, 2004 - November 2004; some on contraceptives pills, were studied by analysis of smear of nasal, pharyngeal and vaginal trough maturation index of exfoliated cells and serum level of estrogen and progesterone. Department of Obstetrics and Gynecology, Hospital Chiquinquira, Maracaibo, Estado Zulia. Venezuela. It was established that exists a good correlation between the superficial and intermediate cells in the different phases of the menstrual cycle and those who received oral contraceptives and the group that did not. Is established that there are correlation between the cells when compared vaginal-pharynx and vaginal-nose, in both groups. The serum levels of estrogen and progesterone were accorded to the cycle phases and with the percentage of cells in both, medicated and non medicated patients. Ours results demonstrate that the nasal and pharyngeal epitheliums respond to ovarian hormones, similar to what occurs in the vagina. It is recommended to use this method in those patients where it is need to investigate the endocrine status and where it is difficult to reach the vagina: nubile girls, vaginal agenesis, imperforate hymen; or where there is not a endocrine laboratory near

Quiste de inclusión vaginal: reporte de un caso / Vaginal inclusion cyst: a case report

We report a case of vaginal cyst after hysterectomy. Its assessment, manegement and therapy.

Presentamos el caso de una paciente que tuvo un quiste de inclusión vaginal, luego de una histerectomía total. Su estudio, manejo y terapia.

Liquid-base cytology: a new method for oestral cycle study in wistar's rats

OBJECTIVES: The objective of this study was the standardization of a collection technique and staining in liquid-base that allies the pratical and cytological wealth, making possible a larger reproductibility and microscopic easiness. METHODS: Female wistar rats (n=20) were submitted to the daily vaginal collection in saline and fastened washed (ether/alcohol) and stained in suspension with a solution of Evans Blue 0.025%. The sample was pondered by centrifugation and observed under lens of 40 x. RESULTS: The stained smears allowed clear differentiation of the phases of hormonal cycle (diestrus, proestrus, estrus and metestrus); besides the differentiation of the cellular types in relation to its maturation degree having as parameters the cellular size, nucleus / cytoplasm relationship (NCR) and ink reaction. The study demonstrated the existence of three basic cellular patterns: cells with low NCR, accentuated cyanophily and small size; cells with increment in NCR, cyanophilic loss and larger volume cytoplasmatic and without nuclei keratinization cells in squamous aspect. CONCLUSION: The staining of the material allowed, besides the cytological classification, the quantification possibility that would result in a perfected accompaniment of the cycle estrous.

OBJETIVOS: O objetivo deste estudo foi à padronização de uma técnica de coleta e coloração em meio líquido que alie a praticidade e a riqueza citológica, possibilitando uma maior reprodutividade e facilidade microscópica. MÉTODOS: Ratas wistar (n=20) foram submetidas à coleta vaginal diária em salina e o lavado fixado (éter/álcool) e corado em suspensão com solução de azul de Evans 0,025%. A amostra foi concentrada por centrifugação e observado sob objetiva de 40 x. RESULTADOS: Os esfregaços corados permitiram nítida diferenciação das fases do ciclo hormonal (diestro, proestro, estro e metaestro); além da diferenciação dos tipos celulares em relação ao seu grau de maturação tendo como parâmetros o tamanho celular, relação núcleo / citoplasma (RNC) e reação tintorial. O estudo demonstrou a existência de três padrões celulares básicos: células com baixa RNC, acentuada cianofília e pequeno tamanho; células com acréscimo na RNC, perda de cianofilia e maior volume citoplasmático e células queratinizadas anucleadas em aspecto de escama. CONCLUSÃO: A coloração do material permitiu, além da classificação citológica, a possibilidade de quantificação o que resultaria em um acompanhamento mais acurado do ciclo estral.