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Does a diagnosis of atrophic vaginitis on Papanicolaou test signify the presence of inflammation?

Heller, Debra S. MD1,2; Weiss, Gerson MD1; Bittman, Sara MD1; Goldsmith, Laura PhD1

doi: 10.1097/GME.0000000000000393
Original Articles

Objective Vaginal atrophy in menopause shows increased parabasal cells on cytology. This may be accompanied by abundant neutrophils. A shift in maturation index in the absence of significant inflammation is more accurately termed “atrophic pattern.” This study aims to determine whether a diagnosis of “atrophic vaginitis” or atrophic pattern on Papanicolaou test is a reliable indicator of what is present on the slide.

Methods A retrospective review of Papanicolaou test slides from University Hospital Newark was performed. Cases that had been diagnosed as either atrophic vaginitis (n = 100) or atrophic pattern (n = 100) were selected. Exclusion criteria included any additional diagnosis of neoplasia. Slides were re-reviewed and scored based on abundance of neutrophils: 0 to 5, 6 to 10, or more than 10 neutrophils per high-power field (×40), with 10 fields per slide reviewed. Data were analyzed by χ2 analysis.

Results Among 200 cases with atrophic vaginitis or atrophic pattern, the proportion of those diagnosed with atrophic vaginitis to those diagnosed with atrophic pattern increased across three neutrophil categories (P < 0.0001).

Conclusions A diagnosis of atrophic vaginitis on Papanicolaou test is reliably associated with increased numbers of neutrophils. A diagnosis of atrophic pattern is indicative of low numbers of neutrophils. As the Papanicolaou test diagnosis of atrophic vaginitis does not correlate with clinical symptoms, a single diagnostic term that does not suggest a disease process would more reliably communicate cytology findings to clinicians.

From the 1Departments of Obstetrics, Gynecology, and Women’s Health, Rutgers New Jersey Medical School, Newark, NJ; and 2Departments of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ.

Received June 16, 2014; revised and accepted October 16, 2014.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Debra S. Heller, MD, Department of Pathology, Rutgers New Jersey Medical School, UH/E158, 185 South Orange Ave, Newark, NJ 07103. E-mail:

© 2015 by The North American Menopause Society.