VAGINAL SMEAR GLYCOGEN: LIMITATIONS AS AN INDEX OF ESTROGEN ACTIVITY*

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Abstract
IT IS now established that the presence of glycogen in the vaginal mucosa is influenced by estrogen. On this basis, the number of epithelial cells in the vaginal smear containing glycogen has been used as an indicator of estrogen activity. The iodine vapor technique, described by Mack (1, 2), is an easy and convenient method of detecting the glycogen-containing cells. Mack has defined the percentage of cells in the smear which give the iodine reaction as the “glycogen index.” His results with the iodine vapor technique have led him to conclude (2) that vaginal smear glycopenia is indicative of advanced or complete estrogen deficiency; and that a high “glycogen index” represents maximal estrogenic effect. It might be expected, therefore, that the activity of large doses of an estrogen administered by the intramuscular route would be reflected by a glycogen-rich smear. This did not prove to be the case. In cytological studies on 6 women receiving large doses of stilbestrol dipropionate, it was observed that the high-cornified smear of hyperestrinism (3) was characterized by a low glycogen content. In 2 cases stilbestrol was administered continuously over a two-month period. Smears taken at regular intervals were composed of many large flat squamous cells with small pyknotic nuclei. Only an occasional glycogen-positive cell was found scattered over the field. The high level of estrogen activity which was maintained was accompanied not by a glycogen-rich smear but by a definite glycopenia.

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