title: The vulval vestibular mucosa-morphological effects of oral contraceptives and menstrual cycle.
abstract: BACKGROUND
  An erythematous and hypersensitive vestibular mucosa has been observed during the use of combined oral contraceptives (COC). Hormonal effects on the vestibular morphology have not been studied.
  
  
  OBJECTIVE
  Our aim was to evaluate the morphology of the vulval vestibular mucosa during the influence of COC and during the menstrual cycle.
  
  
  METHODS
  Forty-five healthy women (20 using COC and 25 not using COC) were included. A 6-mm punch biopsy was obtained from the right posterior vestibule on days 7-11 of the menstrual cycle. A corresponding biopsy was taken 2 weeks later in 16 women without COC. The epithelial morphology was estimated by measuring interdermal papilla distance, dermal papilla to surface, from basal layer to surface and width of dermal papillae. A histopathological assessment was made.
  
  
  RESULTS
  The vulval vestibular mucosa of women using COC displayed a larger distance between the dermal papillae (P = 0.04) and a larger space from the dermal papillae to the epithelial surface (P = 0.03) compared with controls in the follicular phase. Women without COC displayed a larger interdermal papilla distance in the luteal phase compared with the follicular phase, P = 0.02. Histopathology showed more superficial blood vessels in the COC users (P < 0.01).
  
  
  CONCLUSIONS
  The vulval vestibular mucosa of women with COC display an altered morphological pattern with shallow and sparse dermal papillae compared with the follicular phase. Similar findings are seen in women without COC during the luteal phase which indicate a gestagenic effect on the mucosa. Associations between the morphological pattern and changes in mucosal mechanical sensitivity require further studies.
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, 182 88 Stockholm, Sweden. ulrika.johannesson@ds.se
authors.forename: U
authors.initials: U
authors.lastname: Johannesson
authors.forename: B
authors.initials: B
authors.lastname: Blomgren
authors.forename: M
authors.initials: M
authors.lastname: Hilliges
authors.forename: E
authors.initials: E
authors.lastname: Rylander
authors.forename: N
authors.initials: N
authors.lastname: Bohm-Starke
mesh_terms: D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000494:pharmacology*; D004958:Estradiol / Q000378:metabolism; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology*; D009092:Mucous Membrane / Q000187:drug effects / Q000473:pathology; D011374:Progesterone / Q000378:metabolism; D014844:Vulva / Q000187:drug effects* / Q000473:pathology
chemical_list: D003277:Contraceptives, Oral, Combined; D011374:Progesterone; D004958:Estradiol