Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina

• Published in: Cytopathology (Oxford) Vol. 28; no. 3; pp. 184 - 191
• Main Authors: Grosse, A., Grosse, C., Lenggenhager, D., Bode, B., Camenisch, U., Bode, P.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2017
• Subjects: Adult; Aged; Atypical Squamous Cells of the Cervix - pathology; Atypical Squamous Cells of the Cervix - virology; Bacilli; Cancer screening; Cellular biology; Cervix; Cervix Uteri - pathology; Cervix Uteri - virology; Colposcopy; Cytodiagnosis - methods; Cytology; Early Detection of Cancer; Estrogens; Female; high‐grade intraepithelial lesion; Hormone replacement therapy; Human papillomavirus; human papillomavirus infection; Humans; Intestine; Invasiveness; low‐grade intraepithelial lesion; Male; Medical screening; Middle Aged; neovagina; Papillomaviridae - pathogenicity; Papillomavirus Infections - complications; Patients; Penis; Retrospective Studies; Skin; Squamous cells; Squamous Intraepithelial Lesions of the Cervix - pathology; Squamous Intraepithelial Lesions of the Cervix - virology; Transgender Persons; Uterine Cervical Dysplasia - pathology; Uterine Cervical Dysplasia - virology; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Vagina; Vagina - pathology; Vagina - virology; vaginal samples; Young Adult; vaginal samples; cytology; low-grade intraepithelial lesion; high-grade intraepithelial lesion; neovagina; human papillomavirus infection
• ISSN: 0956-5507; 1365-2303; 1365-2303
• DOI: 10.1111/cyt.12417

Objective The primary objective of this study was to describe the cytological findings of bowel and (penile) skin‐lined neovaginas in patients with gender dysphoria (GD) and individuals with a congenital or acquired absence of a natural vagina. The secondary objective was to correlate the cytological findings with clinical characteristics such as oestrogen replacement therapy (ERT). Methods A retrospective review of an institutional pathology archive over a 15‐year‐period was performed to identify cytological samples of neovaginal vaults. The medical and surgical records of the patients identified (n=20) were evaluated. Results Well‐preserved nucleated squamous cells were found in 70% (14/20) of patients. Neovaginal samples showing superficial, intermediate and parabasal cells plus Döderlein flora similar to normal cervical cytology were present in only 10% (2/20). Three samples (15%, 3/20) showed atypical squamous cells of undetermined significance (ASC‐US) that were all negative for high‐risk human papillomavirus (HR‐HPV) types, whereas one case was positive for low‐risk (LR) HPV. One patient (5%, 1/20) was diagnosed with an HR‐HPV‐positive high‐grade squamous intraepithelial lesion (HSIL), and one patient (5%, 1/20) had an HR‐ and LR‐HPV‐positive low‐grade squamous intraepithelial lesion (LSIL). The correlation between the presence of nucleated squamous cells and ERT was significant (P=.032). Conclusion Cytological findings of the neovagina resemble normal cervical cytology with superficial, intermediate and parabasal cells as well as Döderlein bacilli in a minority of cases. Because precancerous lesions and invasive carcinoma may develop in the neovagina, patients with neovaginas should be subject to cancer screening programmes. The cytological findings of bowel and (penile) skin‐lined neovaginas in patients with gender dysphoria (GD) and in individuals with a congenital or acquired absence of a natural vagina resembled the cytology of the normal vagina in only 10%. Sigmoid‐derived neovaginas demonstrated special cytomorphology with a predominance of degenerated columnar cells. Abnormalities of squamous cells were found in 25% of patients, emphasizing the need for patients with neovaginas to engage in cancer screening programmes.