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

A total of 107 sexually active women, aged 18-35 years, was recruited throu gh family planning clinics in four centres in different countries. Each wom an underwent two or three gentle but thorough and systematic vaginal inspec tions 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 u sed, cigarette smoking or other environmental factors. Obvious changes in a ppearance were photographed at x 10 magnification. These 'appearances' or ' conditions' were classified according to a modification of the recommendati ons of a workshop sponsored by the World Health Organization, the Populatio n Council and the Conrad Program. Most of these alterations in the appearan ce of the vaginal epithelium were judged to be of such minor clinical impor tance that they have been termed 'conditions' or 'changes in appearance' ra ther than 'lesions', In all, 56 'conditions' or 'appearances' were noted in 314 inspections, the commonest being petechiae (53.6%). Potentially signif icant conditions justifying the term 'lesions' (three microulcerations, two ecchymoses, five abrasions and one mucosal tear; 3.5% of inspections) usua lly healed spontaneously and disappeared rapidly. The incidence of these co nditions was highest when the inspections followed intercourse in the previ ous 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 mi nor trauma to the vaginal epithelium.