title: Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina.
abstract: OBJECTIVE
  The primary objective of this study was to describe the cytological findings of bowel and (penile) skin-lined neovaginas in patients with gender dysphoria (GD) and individuals with a congenital or acquired absence of a natural vagina. The secondary objective was to correlate the cytological findings with clinical characteristics such as oestrogen replacement therapy (ERT).
  
  
  METHODS
  A retrospective review of an institutional pathology archive over a 15-year-period was performed to identify cytological samples of neovaginal vaults. The medical and surgical records of the patients identified (n=20) were evaluated.
  
  
  RESULTS
  Well-preserved nucleated squamous cells were found in 70% (14/20) of patients. Neovaginal samples showing superficial, intermediate and parabasal cells plus Döderlein flora similar to normal cervical cytology were present in only 10% (2/20). Three samples (15%, 3/20) showed atypical squamous cells of undetermined significance (ASC-US) that were all negative for high-risk human papillomavirus (HR-HPV) types, whereas one case was positive for low-risk (LR) HPV. One patient (5%, 1/20) was diagnosed with an HR-HPV-positive high-grade squamous intraepithelial lesion (HSIL), and one patient (5%, 1/20) had an HR- and LR-HPV-positive low-grade squamous intraepithelial lesion (LSIL). The correlation between the presence of nucleated squamous cells and ERT was significant (P=.032).
  
  
  CONCLUSIONS
  Cytological findings of the neovagina resemble normal cervical cytology with superficial, intermediate and parabasal cells as well as Döderlein bacilli in a minority of cases. Because precancerous lesions and invasive carcinoma may develop in the neovagina, patients with neovaginas should be subject to cancer screening programmes.
authors.affiliation: Institute of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Grosse
authors.affiliation: Department of Pathology, Kepler University Hospital, Linz, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Grosse
authors.affiliation: Institute of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Lenggenhager
authors.affiliation: Institute of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Bode
authors.affiliation: Institute of Clinical Pathology, Diagnostic Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: Camenisch
authors.affiliation: Institute of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Bode
mesh_terms: D000328:Adult; D000368:Aged; D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology / Q000821:virology; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D003127:Colposcopy; D003581:Cytodiagnosis / Q000379:methods; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000150:complications; D012189:Retrospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000473:pathology / Q000821:virology; D063106:Transgender Persons; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology; D014621:Vagina / Q000473:pathology* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology; D008297:Male
keywords: cytology; high-grade intraepithelial lesion; human papillomavirus infection; low-grade intraepithelial lesion; neovagina; vaginal samples