Role of increasing vaginal acidity in histological changes and softening of the cervix prior to dilatation in perimenopausal women

ABSTRACT

Cervical dilatation, along with hysteroscopy or endometrial curettage, is one of the most common procedures in gynecological practice. However, difficulty in entering the internal cervical os may be encountered; Therefore, there is a need for an effective cervical priming agent which can be used in general gynecological practice. Vaginal acidification might increase collagen degradation, It is known that cervical collagen degradation contributes to the ripening process. The present study was designed to evaluate the efficacy of acidifying vaginal cream in cervical tissue remodeling and softening. This study is a double-blinded clinical trial study, conducted in Obstetrics and Gynecology Department of Al-Azhar University Hospital [Damietta]. It included fifty perimenopausal women, their age ranged from 45-55 ys, planned for cervical dilatation before endometrial biopsy due to irregular uterine bleeding. They were divided into two main groups Group I women who were treated with acidifying vaginal cream [Eva base cream melted with acetic acid 5%]. Group II women who were treated with neutral [placebo] vaginal cream [Eva base cream only]. Efficacy of acidifying vaginal cream on the cervix was assessed on the basis of improved cervical softening and degree of cervical changes on the histological examination. There was no significant difference in both groups during the preoperative assessment of the cervix and premedication. During operation in the study group [I] 1[st] Hegar's passed was No8 in 52% of cases and No9 in 28% of cases denoting the significant effect of acetic acid on cervical dilation in comparison with placebo group [II] in which the cervix was closed in 44% of cases and Hegar's No3 passed in 36% of cases showing statistical significance between the two groups. As regards the histological examination, it was found that in group [I] collagen dissociation grade II represent 56% and grade III 24% with statistical significance in comparison with placebo group [II] in which collagen was grade 0, in 76%. Also, the inflammatory changes in group [I] showed moderate changes in 72% of cases and 20% showed severe changes with statistical significance in comparison with the control group [II] in which 56% of cases showed no inflammatory changes. Vaginal acidification with 5% acetic acid as a cervical softening agent appeared to be safe, effective, with no adverse effects