Variations in vaginal epithelial surface appearance determined by colposcopic inspection in healthy, sexually active women

Abstract

A total of 107 sexually active women, aged 18-35 years, was recruited through family planning clinics in four centres in different countries. Each woman underwent two or three gentle but thorough and systematic vaginal inspections using a consistent technique with colposcopic magnification over a 4-6 month period to look for changes in vaginal and cervical appearance which might be related to sexual intercourse, tampon use, contraceptive method used, cigarette smoking or other environmental factors. Obvious changes in appearance were photographed at x10 magnification. These 'appearances' or 'conditions' were classified according to a modification of the recommendations of a workshop sponsored by the World Health Organization, the Population Council and the Conrad Program. Most of these alterations in the appearance of the vaginal epithelium were judged to be of such minor clinical importance that they have been termed 'conditions' or 'changes in appearance' rather than 'lesions'. In all, 56 'conditions' or 'appearances' were noted in 314 inspections, the commonest being petechiae (53.6%). Potentially significant conditions justifying the term 'lesions' (three microulcerations, two ecchymoses, five abrasions and one mucosal tear; 3.5% of inspections) usually healed spontaneously and disappeared rapidly. The incidence of these conditions was highest when the inspections followed intercourse in the previous 24 h (25.2 versus 14.2%; P < 0.0008), or tampon use (32.4 versus 15.9%; P < 0. 0001). These processes may be regarded as a reflection of regular minor trauma to the vaginal epithelium.

Fourteen-day safety and acceptability study of 6% cellulose sulfate gel: a randomized double-blind Phase I safety study

“…Thus, CS does not appear to cause more epithelial disruption than K-Y. At least one colposcopic finding was observed in 60% of sexually abstinent women and in 47% of sexually active women, which was somewhat reversed from an earlier observational study in which colposcopic findings were seen in 25% of women examined within 24 h of vaginal intercourse compared with 14% of women who abstained [13]. It is possible that the gel provided some type of protection in sexually active women, although other possibilities are plausible.…”

Changes in genital injury patterns over time in women after consensual intercourse

“…1,2,[9][10][11][12] All six of the studies investigated genital injuries after consensual intercourse either as part of larger study to investigate differences between consensual and non-consensual intercourse or to explore the efficacy of injury detection tools used following sexual assaults injury rates ranged from 5 to 61%. 10 Methodological differences made comparisons difficult.…”

“…Studies varied based on time from intercourse to examination, age ranges, tools used to identify injuries, and how participants were recruited. Time from intercourse to examination ranged from 0-6 h; 10 0-24 h 1,2 and greater than 24 h. [9][10][11][12] The group seen within 6 h of intercourse 10 had the highest injury rate (61%). By increasing time from intercourse to examination to 24 h, two studies reported injury rates of 11% 10 and 30%.…”

Defining Patterns of Genital Injury From Sexual Assault

“…This proportion of injury is similar to those found by other investigators in the consensual sex population (Lauber & Souma, 1982;Slaughter et al, 1997). Fraser and colleagues followed 107 sexually active women, age 18 to 35 years, over a 6-month period to look for changes in vaginal and cervical appearance (Fraser et al, 1999). In 3.5% of the 314 inspections, investigators found a total of 11 abnormalities: 3 ulcerations, 2 ecchymoses, 5 abrasions, and 1 tear.…”