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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
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ABSTRACT 

The process of formation of congenital anomalies occurs during certain time periods when organs are in a critical 

stage of development, known as organogenesis. At the stages of organogenesis, intensive formation and further 

development of organs occurs. 

KEYWORDS 

Organogenesis, dysmorphogenesis, colpopoiesis. 

INTRODUCTION

The process of formation of congenital anomalies 

occurs during certain time periods when organs are in 

a critical stage of development, known as 

organogenesis. At the stages of organogenesis, 

intensive formation and further development of 

organs occurs. If damage or developmental delay 

occurs during these stages, it may be caused by 

exposure to substances known as teratogens. When 

the differentiation process is stopped, embryonic 

structures characteristic of a certain stage of organ 

development may be preserved (13, 23, 28). In recent 

years, there has been an increase in the detection of 

developmental defects of various organs and systems, 

including anomalies in the development of the genitals 

  Research Article 

 

REACTIVE CHANGES IN THE CELLS OF THE MUCOUS MEMBRANE OF THE 

ARTIFICIAL VAGINA IN PATIENTS WITH AGENESIS OF THE GENITAL 

ORGANS 
 

Submission Date: May 21, 2024, Accepted Date:  May 26, 2024,  

Published Date: May 31, 2024  

Crossref doi: https://doi.org/10.37547/ajbspi/Volume04Issue05-10 

 

 

Khamidova Farida Muinovna 
Samarkand State Medical University, Uzbekistan 

 

Yakubov Munis Zakirovich 
Samarkand State Medical University, Uzbekistan 

Journal Website: 

https://theusajournals.

com/index.php/ajbspi 

Copyright: Original 

content from this work 

may be used under the 

terms of the creative 

commons attributes 

4.0 licence. 

 

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Volume 04 Issue 05-2024 64 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
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in girls (19). Failures in the development of female 

genital organs account for 4% to 14% of all congenital 

anomalies. Among them, the most socially significant 

anomaly is aplasia of the vagina and uterus, which 

occurs with a frequency of approximately 1 case per 

4500-5000 live births of female children. (1,2,30,31). 

Aplasia of the vagina and uterus, also known as Mayer-

Rokitansky-Küster-Hauser syndrome (MRKHS), 

although not life-threatening, is a serious problem 

associated with psychological, social and reproductive 

difficulties. Modern advances in medicine make it 

possible to restore reproductive function in cases of 

complete infertility. However, the inability to engage in 

sexual activity is a source of significant emotional 

distress (1,4). So, aplasia of the uterus and vagina, also 

known as Rokitansky-Küster-Mayer syndrome, this 

condition is an extreme form of congenital 

dysmorphogenesis, which means underdevelopment 

of the organs of the reproductive system (26). Surgical 

treatment for aplasia of the uterus and vagina is aimed 

at creating an artificial vagina (colpopoiesis) in order to 

restore sexual function. The approach to surgical 

treatment in this case remains controversial: as a 

necessity only in the presence of functional activity or 

in pain (2,3,23). Genital prolapse, more often observed 

after reconstructive vaginal surgery for various 

reasons, is becoming a significant medical, social and 

economic problem, especially in the context of 

increasing life expectancy (18,20). According to WHO 

forecasts, by 2030 the number of women aged 80 

years and over is expected to quadruple. This means 

that the problem of genital prolapse is becoming more 

pressing every year (8, 15,21). When women reach 80, 

one in five may require surgery for genital prolapse 

(32). In Russia, the incidence of genital prolapse varies 

from 15.0% to 40.0%. It accounts for approximately 

15.0% of all gynecological interventions (18, 20,21). The 

peak incidence occurs at ages 50 years and older 

(14,32). Currently, there are approximately 300 

methods of surgical treatment of genital prolapse, 

most of them based on minimally invasive approaches 

using various synthetic implants (10,11,17). Therefore, 

the incorrect choice of method for surgical treatment 

of genital prolapse and insufficient use of rational 

antibiotic therapy in the postoperative period may 

explain the high rate of recurrence of the disease (22). 

Research by Huser M. et al. (2012) and Togami J.M. et 

al. (2012) show that the recurrence rate when 

correcting genital prolapse using own tissue is 20.0–

40.0%, while when using mesh implants this figure 

ranges from 3.0 to 20.0% (9.5 ,6,15). Genetically 

determined processes associated with the pathology 

of the synthesis of elastic fibers in the connective 

tissue of the pelvic floor structures were studied. The 

importance of the activity of matrix enzymes FBLN5, 

LOXL-1, MMP-2 and MMP-9 in various components of 

connective tissue, such as epithelium, vascular 

endothelium, extracellular matrix and fibroblasts, was 

revealed in various degrees of pelvic organ prolapse. In 

more complex cases of predicting the development of 

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Volume 04 Issue 05-2024 65 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
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pelvic organ prolapse, genetic research can be 

supplemented by studying the activity of FBLN5 and 

MMP-9 in vaginal tissue, which complements genetic 

research in the diagnosis of preclinical forms of genital 

prolapse (12,25). The creation of an artificial vagina is a 

significant achievement in the field of plastic 

gynecology, providing women with optimal conditions 

and a natural opportunity for drainage of menstrual 

blood after surgery to create a neovagina. The primary 

material used for neovagina is the sigmoid colon, 

although other areas of the colon may occasionally be 

used (26,27). However, there is a lack of long-term 

clinical and morphological assessment with a complete 

study of adaptation processes over many years of 

functioning (16,17). This situation indicates a lack of 

specific data to study and evaluate the direction and 

characteristics of adaptive processes in the areas of the 

gastrointestinal tract used to create the neovagina 

(17,19). The issue of expanding and improving the 

optimal selection of segments for detubularization 

remains important, taking into account the individual 

characteristics of the patient and the long-term 

functioning of the artificial vagina. This highlights the 

need for a broad, comprehensive comparative analysis 

of clinical, endoscopic, morphological and 

immunohistochemical data (16). Histological 

examination of samples of a removed rudimentary 

uterus with complete aplasia of the cervix revealed 

severe dysplasia of the uterine tissue at the 

microscopic level: the uterine wall is represented by 

muscle tissue, which contains myocytes with 

pronounced signs of dystrophy, as well as areas of 

loose and rough connective tissue with areas of 

calcification. The endometrium covering the uterine 

cavity shows signs of atrophy. The cervical canal and 

cervix are absent. Histological examination of biopsies 

of a partially aplastic vagina also shows deep dysplastic 

changes at the cellular and tissue levels, which 

correlate with the level of vaginal aplasia. The degree 

of dysplastic lesions of the vaginal tissue is considered 

more pronounced with a higher level of aplasia.   

(7). The main treatment method for this disease, 

including Rokitansky-Küster-Mayer syndrome, is the 

creation of an artificial vagina, or colpopoiesis. There 

are a variety of conservative and surgical methods for 

this purpose in the world. Vaginal dilatation, or 

colpoelongation, which is based on mechanical 

traction of the vulva's own tissues, is widely used as the 

first line of therapy in various countries. This method is 

characterized by the absence of surgical risk and 

demonstrates high clinical effectiveness (90-96%) (29). 

In connection with the above, there is no doubt about 

the need to search for methods of diagnosis, prognosis 

and increase the effectiveness of treatment in patients 

with aplasia of the uterus and vagina. In addition, 

studying the condition of the neovagina created from 

the sigmoid colon, assessing the structural changes in 

the transformation of single-layer epithelium into 

multilayer epithelium observed in it makes it possible 

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Volume 04 Issue 05-2024 66 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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to predict the survival rate of the neovagina of 

patients. Despite the large number and type of surgical 

interventions to create a neovagina, morphological 

changes, including cytological studies, have not been 

fully studied. 

Purpose of the study: comparative cyto-morphological 

assessment of the colonic variant of vaginoplasty in the 

early and late stages of functioning, establishing, 

based on cytological studies, the biological features of 

the adaptation process with an individual prognostic 

assessment. 

METHOD 

The material was biopsy samples obtained after 

vaginoplasty in women who underwent surgery to 

create an artificial vagina. A comparative analysis of the 

results of cytological examination and treatment of 52 

women was carried out. To study the morphological 

changes of the neovagina, samples for cytological and 

histological examination were taken from 34 patients 

with congenital anomalies of the vagina after surgery 

to create a neovagina. The average age was 24±7.5 

years, in addition, a control group of 6 healthy 

individuals was selected. Inclusion criteria were: a 

confirmed diagnosis of Mayer-Rokitansky-Küster-

Hauser syndrome and surgery for vaginal 

reconstruction; diagnosis and surgical treatment were 

performed depending on the anatomical form of the 

malformation, patient complaints, clinical 

manifestations and according to the ICD classification 

(Q51.8); a gentle method to prevent a risky procedure; 

early diagnosis of malignant processes; early diagnosis 

of neovaginal prolapse; associated with tissue biopsy; 

verification of tissue accommodation; early diagnosis 

of dysplastic and hyperplastic processes of the 

neovagina; Scientific research; After surgery to create 

a neovagina, all patients in the study groups were 

regularly examined by gynecologists and smears were 

taken for cytological examination of mucosal cells. 

Cytological examination of biopsy samples of the 

mucous membrane of the sigmoid colon was carried 

out from 1 to 10 years from the date of surgery. 

Classical cytology was performed. A special instrument 

(brush) was used to take a smear from the mucous 

membrane of the neovagina. A smear was applied with 

a brush onto dry glass, fixed, air dried and then stained. 

Manual staining of finished cytological preparations 

using a set of fixative and dyes “Leukodif 200”. The 

patients' smears were processed and stained using the 

Romanovsky-Giemsa method and the Pappenheim 

method. To obtain statistically reliable results, at least 

100 objects were analyzed in several fields of view. A 

morphometric study was carried out with the 

calculation of the following parameters: the number of 

neutrophil leukocytes, lymphocytes and epithelial cells 

was counted, after which the neutrophil-epithelial 

index (NEI) and lymphocyte-epithelial index (LEI), as 

well as the nuclear-cytoplasmic ratio of the surface cell 

layer (NSL) were calculated. Cytogram data were taken 

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Volume 04 Issue 05-2024 67 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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as the initial indicator. Statistical data processing. 

When studying micropreparations, cytological and 

cytomorphometric analyzes were performed. 

Cytomorphometric analysis was carried out using a 

scanner on a NanoZoomer microscope (REF C13140-

21.S/N000198/HAMAMATSU PHOTONICS/431-

3196JAPAN), using the NDP.VIEV2.0.,QuPath.0.4.0.url 

program.  

RESULTS  

The main groups of patients were divided into 3 

subgroups:  

1- patients with vaginal prolapse after surgery to 

create a neovagina after 1 year (12 patients); 

2-  patients with vaginal prolapse after surgery to 

create a neovagina after 3 years (14 patients);  

3- patients with vaginal prolapse after surgery to 

create a neovagina up to 10 years of age (8 patients); 

We performed a cytological study of the preparations 

in order to study the dynamics of the reparative 

processes of the neovaginal mucosa. The results of a 

cytological study showed that in patients with vaginal 

prolapse after surgery to create a neovagina after 1 

year, the epithelium of the mucous membrane of 

patients aged 18-25 years was observed, indicating the 

presence of squamous epithelial cells and cellular 

accumulations of unchanged glandular epithelium. 

Using the cytological method, we also studied the 

dynamic change in the number of neutrophils, 

lymphocytic leukocytes and epithelial cells. The 

cytogram results showed that often in our 

observations in the group of women with neovagina 

there was a reduced number of superficial cells 

compared to intermediate and keratinizing cells.  In the 

intermediate cells, slightly enlarged vesicular nuclei 

were found, which indicate esterogen deficiency. 

Along with them, cells of the upper rows of the 

superficial or intermediate layer can be found. In some 

cases, smears are represented by cells of the surface 

functional epithelium. In this observation group, 

patients partially produced esterogen (Fig.1). Such a 

picture of a smear is due to the body’s good 

compensatory abilities. 

                 

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Volume 04 Issue 05-2024 68 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

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OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Fig.1. Cytogram of a patient in the observation group 1

 year after surgery. Cells of squamous epithelium of the superficial and intermediate type. Poor microflora. The 

mucous membrane of the neovagina. Pappenheim staining, X40. 

  

          

Fig.2. Cytogram of a patient in the observation group 1

 year after surgery. Cells of squamous epithelium of the superficial and intermediate type. Degenerative changes in 

the cells of the surface layer. The mucous membrane of the neovagina. Pappenheim staining, X40. 

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Volume 04 Issue 05-2024 69 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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In summary, the data demonstrate that women with 

neovagina exhibit significant changes in the nuclear-

cytoplasmic ratio in various mucosal cell types 

compared with controls. The stability of the NVC in the 

control group contrasts with the variability of 

indicators in the group of women with neovagina, 

which may indicate more pronounced adaptation and 

regenerative processes in the mucous membrane of 

the neovagina. In addition, in the observation group 

for the period of 3 and 10 years, clusters of 

intermediate and large parabasal cells were noted in 

the smears. All cells are well preserved, their nuclei are 

enlarged, equally large and poorly colored. The 

increase and accumulation of intermediate and 

parabasal cells demonstrates a pronounced estrogen 

deficiency (Fig.3.,4). 

       

Fig.3. Cytogram of a patient in the observation group 4 years after surgery. Squamous epithelial cells of the 

superficial, intermediate and parabasal type. Destroyed cells of the parabasal layer in the form of "naked" nuclei. 

neovagina. Painting by Romanovsky-Gimse, X40. 

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Volume 04 Issue 05-2024 70 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Fig.4. Cytogram of a patient in the follow-up group 6 years after surgery. The cells of the squamous epithelium are 

of a superficial, intermediate type. The surface cells are polygonal, fusiform, with karyorexis and karyopycnosis of 

the nuclei. Destroyed intermediate-type cells. neo vagina. Pappenheim coloring, X40.

So, cytological examination of smears in women with 

neovagina, especially in the periods 3 and 10 years after 

surgery, revealed significant changes indicating 

estrogen deficiency. Clusters of intermediate and 

parabasal cells with enlarged, weakly colored nuclei 

are observed. These changes are especially 

pronounced in women with aplasia of the uterus and 

appendages. Characteristic smears of the menopausal 

type, with the predominant presence of parabasal cells 

and signs of dystrophy, confirm insufficient hormonal 

stimulation and pronounced changes in the cellular 

composition of the neovaginal mucosa. 

In addition, our observation groups included patients 

with impaired gender formation (Female and male 

false hermaphroditism). In the vaginal smears of these 

patients, mainly cells of the lower rows of the surface 

layer were found, with the presence of cells of the 

upper rows of the intermediate epithelium. In addition, 

the smears are represented relatively by cells with 

signs of atypia (Fig.5.,6). 

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Volume 04 Issue 05-2024 71 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Fig.5. Cytogram of a patient in the follow-up group 10 years after surgery. The smear contains single cells of the 

squamous epithelium of the superficial, intermediate type. Surface cells, with karyorexis and karyopycnosis of the 

nuclei. Neovagina. Atrophic type of smear. Pappenheim coloring, X40. 

 

Fig.6. Cytogram of a patient in the follow-up group 10 years after surgery. The smear contains abundant squamous 

epithelial cells of the superficial and intermediate type. The surface cells are wrinkled, pyknotic, with karyorexis 

and karyopycnosis of the nuclei. Neovagina. Atrophic type of smear. Pappenheim coloring, X40. 

Patients with impaired sex formation (female and male 

false hermaphroditism) showed specific changes in 

cytological smears. The main composition of cells is 

represented by cells of the lower rows of the surface 

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Volume 04 Issue 05-2024 72 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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layer and the upper rows of the intermediate 

epithelium. 

The presence of cells with signs of atypia indicates 

possible pathological changes and requires further 

observation and analysis. These data emphasize the 

need for an individual approach in the diagnosis and 

treatment of patients with similar gender formation 

disorders. Since these patients lack ovarian function, 

they are partially compensated by adrenal harmonics, 

which enhance the release of androgen. Androgen acts 

on the vaginal epithelium and causes changes in 

epithelial cells, mainly by increasing the surface layer 

and intermediate type. 

This smear of the patients is typical for the androgenic 

type of smear. Thus, estrogenic insufficiency causes 

the impossibility of complete maturation 

(differentiation) of the multilayer squamous 

epithelium. Due to the disappearance of the superficial 

– mature layers, the mucous membrane of the vagina 

is thinned, and the smear pattern is mainly represented 

by deep layers of the epithelium. Such changes in their 

smears proved a complete lack of estrogens and 

atrophy of the vaginal mucosa. And so, estrogen 

deficiency in patients with impaired sex formation 

leads to the impossibility of complete aging of the 

vaginal epithelium, which manifests itself in thinning of 

the mucous membrane and the predominance of deep 

layer cells in smears. 

These changes indicate the complete absence of 

estrogens and atrophy of the vaginal mucosa, 

confirming the need for careful hormonal control and 

an individual approach in the treatment of this group 

of patients. 

Table 1 shows changes in the nuclear-cytoplasmic ratio 

(NCC) in various types of cells of the flat non-

corneating epithelium of the neovagina in comparison 

with the control group over three periods: up to 1 year, 

up to 3 years and up to 10 years after surgery. 

Table No. 1. 

Dynamic changes in the nuclear-cytoplasmic ratio in smears-prints of the neovagina mucosa (microns) 

Observation 
period 

Types of cells of the flat 
non-corneating 

epithelium neovagines 

Nuclear-cytoplasmic 
ratio of cells in the 

control group 
(n=20) 

Nuclear-cytoplasmic 
ratio of neovaginal 

mucosal cells in 
women of the 

observation group 
(n=34) 

Up to 1 year Surface cells 50:5 microns 
(1:10) 

33:5 microns 
(1:6) 

Intermediate cells 30:6 microns 
(1:5) 

24:6 microns 
(1:4) 

Basal cells 15:5 microns 25:5 microns 

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Volume 04 Issue 05-2024 73 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 05 PAGES: 63-80 

SJIF IMPACT FACTOR (2022: 5. 705) (2023: 6.534) (2024: 7.7) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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(1:3) (1:5) 

Up to 3 years 
old 

Surface cells 50:5 microns 
(1:10) 

47:7 microns 
(1:6) 

Intermediate cells 30:6 microns 
(1:5) 

56:6 microns 
(1:9) 

Basal cells 15:5 microns 
(1:3) 

48:6 microns 
(1:8) 

Up to 10 years 
old 

Surface cells 50:5 microns 
(1:10) 

74:7 microns 
(1:10) 

Intermediate cells 30:6 microns 
(1:5) 

67:8 microns 
(1:8) 

Basal cells 15:5 microns 
(1:3) 

56:9 microns 
(1:6) 

The surface cells of the mucous membrane, which is 

covered with a multilayer flat non-corneating 

epithelium, in women in the control group from 1 year 

to 10 years of follow-up, the NCC is 1:10 (50:5 microns). 

In women with neovagina, at 1 year 1:6 (33:5 microns), 

at 3 years of follow-up 1:6 (47:7 microns) and at 10 years 

of follow-up, the JCC gradually increases to 1:10 (74:7 

microns). In intermediate cells, there are also changes 

in the JCC in women with neovagina, these indicators 

show a gradual increase in them. If for 1 year they were 

1:4 (24:6 microns), for 3 years 1:9 (56:6 microns), then 

for 10 years of follow-up the indicators increased 

markedly by 1:8 (67:8 microns). 

At the same time, the indicators of the JCC in the 

control group are 1:5 (30:6 microns). 

The JCC of the basal cells of the multilayer squamous 

epithelium of the mucous membrane of the neovagina 

radically change their indicators from 1 year of 

observation 1:5 (25:5 microns), to 3 years 1:8 (48:6 

microns) and after 10 years, 1:6 (56:9 microns). In the 

control group, the JCC is 1:3 (15:5 microns). 

Thus, the JCC of surface cells in the control group 

remains stable at the level of 1:10 throughout the entire 

period, whereas in the comparison group with 

neovagine, fluctuations from 1:6 to 1:10 are observed. 

The JCC of intermediate cells is stable at level 1:5. In 

neovagin, it changes from 1:4 to 1:9. The number of 

basal cells is constant (1:3). In neovagin, it varies from 

1:5 to 1:8. These data demonstrate changes in the 

nuclear-cytoplasmic ratio in various types of cells of the 

neovagin mucosa compared with the control group. 

The results of our observations showed that in patients 

with vaginal prolapse after surgery to create a 

neovagina after 1 year, cylindrical epithelial cells, 

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parabasal, basal cells were found in vaginal smears. 

They had obvious inflammatory cell infiltrates. 

Infiltrates mainly consisted of lymphocytes, 

neutrophils and fibroblasts. 

In addition, in the smears of patients with vaginal 

prolapse after surgery to create a neovagina after 3 

years, mainly surface cells in a state of dystrophy of the 

cells of the cylindrical epithelium were found. 

Basal cells were subjected to hyperplasia and 

hyperchromia. Parabasal cells were located separately. 

The smears were dominated by lymphocytic cells 

rather than neutrophilic leukocytes and fibroblasts. 

In the smears of patients with vaginal prolapse after 

surgery to create a neovagina up to 10 years old, cells 

of the intermediate epithelium were usually found, 

separate cells of the parabasal layer and the basal layer 

appeared in a state of hyperplasia and dysplasia (Fig.7). 

In them, the nuclei are hyperchromic, in some epithelial 

cells with doubled nuclei. Lymphocytes also 

predominated in the smears of patients in this 

observation group, rather than neutrophilic leukocytes 

and fibroblasts (Fig.8.,9). 

 

Fig.7. Cytogram of a patient in the follow-up group 1 year after surgery. Degenerative changes in the cells of the 

cylindrical epithelium in the mucus strands. Single surface cells with karyorexis and karyopycnosis of the nuclei. 

Pronounced lymphocytic infiltration of the mucous membrane of the neovagina. Pappenheim coloring, X40. 

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Fig.8. Cytogram of a patient in the observation group 3 years after surgery. In smear b, there is pronounced 

lymphocytic infiltration, surface and intermediate cells in a state of dystrophy and hyperkeratosis. Neovagina. 

Painting by Romanovsky-Gimse, X40. 

      

Fig.9. Cytogram of a patient in the follow-up group 8 years after surgery. Single surface cells with degenerative 

changes. Stroma reaction (neutrophils and multinucleated histiocytes). Pappenheim coloring, X40. 

So, in patients with vaginal prolapse, after surgery to 

create a neovagina, significant changes in the cellular 

composition in the smears are observed. Inflammatory 

infiltrates predominate for 1 year, after 3 years the 

number of dystrophic and hyperplastic cells increases, 

and by the age of 10 signs of dysplasia appear. 

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Lymphocytes predominate throughout the 

observation period, indicating a chronic inflammatory 

process. These data emphasize the need for long-term 

follow-up and treatment adjustments to prevent 

complications and maintain the health of the 

neovaginal mucosa. 

In addition, dynamic changes in the nuclear-

cytoplasmic ratio in smears-prints of the mucous 

membrane of the neovagina were studied. From Table 

No. 1. it can be seen that the quantitative indicators of 

neutrophils, lymphocytes and epithelial cells differ 

compared to the control group. The cellular 

composition of the control group of neutrophilic 

leukocytes ranged from 15.45% to 17.55%, with a return 

to 15.65% after 10 years. The indicators of postoperative 

neovagina show a gradual decrease from 94.70% to 

68.45% after 10 years. 

If the lymphocyte counts of the control group remain 

stable at about 16% throughout the entire period, then 

in the group of women with neovagina they range 

from 95.45% to 85.50% after 10 years. 

In the control group of observation, epithelial cell 

counts gradually increase with the age of women and 

the period of observation, they have an increase from 

67.80% to 85.48% after 10 years. 

Whereas in women with neovagina, the number of 

epithelial cells was reduced by 1 year of follow-up 

(34.52%) and gradually increased by 3 and 10 years from 

34.52% to 54.73%. This cytological picture corresponds 

to the degenerative-inflammatory period after the 

surgical process. 

 

Table No.1. 

Dynamic changes in quantitative indicators of neutrophilic leukocytes (%) in smears of the neovaginal 
mucosa 

Observation 
period 

The number of neutrophils in the control 
group (n=18) 

The number of neutrophilic 
leukocytes, (%) 

Up to 1 year 15,45±0,32 94,70±0,76 

Up to 3 years 
old 

17,55±1,08 87,65±0,38 

Up to 10 years 
old 

15,65±0,32 68,45±3,43 

Observation 
period 

The number of lymphocytes in the control 
group (n=18) 

The number of lymphocytes in 
women with neovagina, (%) 

Up to 1 year 16,05±0,64 95,45:0,32 

Up to 3 years 
old 

15,95±1,51 90,55±1,08 

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VOLUME 04 ISSUE 05 PAGES: 63-80 

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Up to 10 years 
old 

15,97±1,51 85,50±0,32 

Observation 
period 

The number of epithelial cells in the control 
group (n=18) 

Number of epithelial cells, (%) 

Up to 1 year 67,80±0,42 34,52±1,50  

Up to 3 years 
old 

73,65±1,06  46,67±1,30 

Up to 10 years 
old 

85,48±0,62 54,73±1,70  

DISCUSSION OF THE RESULTS 

The results of the cytogram showed the following 

features of the cellular composition in women with 

neovagina, there is often a decrease in the number of 

surface cells compared with intermediate and 

keratinizing cells. Enlarged vesicular nuclei were found 

in intermediate cells, which may indicate a lack of 

estrogens. There may be a variety of cells in the 

smears. In some cases, smears are represented by cells 

of the superficial functional epithelium. In patients 

who partially produce estrogen, which is reflected in 

the presence of cells characteristic of the superficial 

functional epithelium. Such a cytogram is due to the 

good compensatory abilities of the body, which 

partially compensates for the lack of estrogens. These 

cytograms demonstrate that women with neovagina 

have a decrease in the number of surface cells, an 

increase in vesicular nuclei in intermediate cells and the 

presence of cells of the upper layers of the epithelium. 

These changes indicate insufficient estrogenic 

stimulation, but also indicate significant compensatory 

abilities of the body to maintain partial estrogenic 

activity. 

Data analysis shows that the nuclear-cytoplasmic ratio 

(NCC) of surface cells in the control group remains 

stable at 1:10 throughout the entire follow-up period, 

while fluctuations from 1:6 to 1:10 are observed in the 

group of women with neovagina. 

The JCC of intermediate cells also remains stable at the 

level of 1:5 in the control group, but in women with 

neovagina it varies from 1:4 to 1:9. The number of basal 

cells in the control group is constantly 1:3, whereas in 

women with neovagina it varies from 1:5 to 1:8. 

CONCLUSION 

It can be concluded that women with neovagina have 

significant changes in the cellular composition of the 

mucous membrane compared with the control group. 

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VOLUME 04 ISSUE 05 PAGES: 63-80 

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Neutrophilic leukocytes and lymphocytes decrease 

more markedly in women with neovagina, whereas 

epithelial cells show an increase over time, but remain 

below the values of the control group throughout the 

entire follow-up period. 

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