title: Vaginal maturation index self-sample collection in mid-life women: acceptability and correlation with physician-collected samples.
abstract: OBJECTIVE
  During menopause, the ratio of the three vaginal epithelial cell types (parabasal, intermediate, and superficial) changes. The proportion of these vaginal cell types is categorized by the vaginal maturation index (VMI). The VMI provides an objective assessment of vaginal hormone response as well as overall hormonal environment. The aim of this study was to determine the concordance of self- and physician-collected samples for VMI and evaluate participant preference for self-collection.
  
  
  METHODS
  Twenty women aged 42 to 67 years were enrolled. Each woman received instructions and self-collected a sample for VMI analysis from her posterior lateral vaginal walls. Next, she underwent a vaginal speculum examination for physician VMI sampling. Finally, she completed a survey regarding sampling preference, ease of self-sampling, and previous vaginal experience. Correlation between physician- and self-collected samples were calculated using Pearson's correlation coefficient and Cronbach's alpha. Participant characteristics, vaginal experiences, and sampling preferences were summarized using frequencies and measures of central tendencies. The relationships between preference for sampling method and previous vaginal experiences were examined using Fisher's exact test.
  
  
  RESULTS
  Average age of the 20 participants was 52.2 years (range, 42-67 y). Women had a variety of previous vaginal experiences ranging from tampon use (100%) to previous vaginal self-swabbing (15%). Average self-collected VMI was 48.4 (range, 13.8-83.5) and physician-collected VMI was 49.9 (range, 20.5-83.5) with a correlation of 0.97 (P < 0. 001), alpha = 0.94. The majority of women preferred self-collection (80%) to physician collection, and there was no difference in preference based on previous vaginal experiences. Nineteen women (95%) found the self-collection to be very easy, and one found it to be somewhat easy.
  
  
  CONCLUSIONS
  Women can reliably self-collect samples for VMI, and the majority of women in our study preferred self-collection to physician collection. Vaginal self-sampling allows this technique for measuring overall hormonal environment to be used in clinical and epidemiological research.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. hessr@upmc.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
authors.forename: R Marshall
authors.initials: RM
authors.lastname: Austin
authors.forename: Stacey
authors.initials: S
authors.lastname: Dillon
authors.forename: Chung-Chou Ho
authors.initials: CC
authors.lastname: Chang
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Ness
mesh_terms: D000328:Adult; D000368:Aged; D004847:Epithelial Cells / Q000166:cytology; D005260:Female; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D012648:Self Care; D013048:Specimen Handling; D014621:Vagina / Q000166:cytology*; D014626:Vaginal Smears