THE GLYCOGEN-ESTROGEN RELATIONSHIP IN THE VAGINAL TRACT

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Abstract
A DIRECT relationship between estrogenic activity and the concentration of glycogen in the vaginal epithelium has been stressed by a number of investigators (1, 2, 3, 4, 5). There has been evidence to show that the glycogen content of the vaginal fluid is similarly influenced (5, 6, 7, 8, 9). Accordingly, the percentage of glycogen-containing cells in the epithelial smear (the glycogen-index) has been applied as an index of estrogenic activity (8, 9). It was recently demonstrated (10), however, that the glycogen index is not reliable when hyperestrinism is induced. With further study it has been observed that changes in the vaginal fluid upon estrogen withdrawal following hyperestrinism are also unusual. These further observations are described in the following report. Since the characteristics of the vaginal smear under these conditions are not in conformity with the glycogen-estrogen relationship as previously described, a modified concept of tliis relationship is suggested. The previously reported study (10) set forth data on 6 subjects with small anaplastic lesions of the cervical epithelium, who were treated with estrogens. Vaginal smears were taken according to Papanicolaou's technique (11) and stained for glycogen with Best's carmine (12). When hyperestrinism was established the vaginal smear was found to be glycopenic in character. Further study has shown that upon the withdrawal of estrogen the glycogen content of the vaginal fluid remains unchanged for a variable period. It then increases and glycogen is found in the smear in appreciable concentrations. The reappearance of glycogen in large amounts was particularly striking in 2 cases in which the effect of ovarian activity was excluded. A paradoxically high vaginal fluid glycogen content persisted, in these cases, over a period of several months of apparent estrogen deprivation. Subsequently, the amounts present gradually decreased and glycopenia developed, coinciding with the development of epithelial atrophy.