Cytopathologic changes associated with intrauterine contraceptive devices. A review of cervico-vaginal smears in 350 women.

ABSTRACT

Cervico-vaginal smears from 350 IUCD users were analysed to ascertain the range of abnormalities induced in the genital tract of these women. Alteration of the microbial environment, inflammatory, degenerative, reparative and proplastic epithelial changes were the salient cytological findings. The clinical implications of these are briefly discussed.

ABSTRACT

PIP Researchers examined results of cervico-vaginal smears of 350 women aged 23-45 years fitted with IUDs at various family planning clinics in Kuala Lumpur, Malaysia, to examine abnormalities in their genital tract. All the women had undergone preinsertion cervico-vaginal smears. They used the IUD for 1-8 years. Around 66% exhibited symptoms after IUD insertion. 40% had vaginal discharge, especially mucous. 3% had pelvic pain and intermittent low grade fever, suggesting pelvic inflammatory disease. 80% had an increase in the number of leukocytes in their blood. 42% had an increase in the number of histiocytes with multinucleate giant forms. The following microorganisms were present Gardnerella vaginalis (42%), Trichomonas vaginalis (32%), Candida (28%), Actinomyces-like organisms (2%), and non-pathogenic Amoeba (0.6%). Both endocervical and squamous columnar cells exhibited morphological atypias (inflammatory, degenerative, or reparative changes). 70% of atypias were benign and varied from mild to severe. 14 women (4%) had cervical intra-epithelial neoplasia (CIN). 3% of the women had atypical single cells. The IUDs were removed from all of these women. 6 months after IUD removal, the cervixes with mild dysplasia had reverted to normal. Two women with severe dysplasia underwent cervical biopsy, which revealed a CIN III lesion. 28% of smears had abnormal or irritated glandular epithelial endocervical and endometrial cells with hyperchromatic nuclei, an increased nucleo-cytoplasmic ratio, and bubble-gum vacuolation of the cytoplasm. 31% of the women had normal or inflamed out-of-phase (beyond day 11 of the menstrual cycle) endometrial cells. 80% of these 109 women had menorrhagia or intermenstrual bleeding. The researchers recommend that serious epithelial atypias be followed up and the IUD be removed. IUD removal allows clinicians to determine whether atypias will regress in the absence of an IUD or are truly neoplastic.