THE STRUCTURE AND BACTERIOLOGY OF THE PREMENARCHAL VAGINA

The changes that occur in the vagina between birth and the menarche are of interest because of their relation to a number of conditions affecting the child’s health. This paper does not consider in depth those changes as regards detailed anatomy and microbiology, but does consider the morphology and bacteriology of the premenarchal vagina from the broader aspect of their relationship to the clinical problems that confront the clinician interested in pediatric gynecologic problems. The descriptive material presented herein has been drawn in part from investigative reports that have appeared in the literature during the past 4 and in part from my own examination of 552 premenarchal patients. The latter group includes 21 girls who showed signs of cexual precocity, 14 who were either true hermaphrodites or pseudohermaphrodites, 12 who suffered from gonadal dysgenesis, 6 who had congenital anomalies of the vagina not secondary to congenital adrenocortical hyperplasia, 51 who had labial adhesions that were not congenital, and 5 who had lichen sclerosus et atrophicus. In addition, there was a number of single cases in which study of the clinical problems has been helpful in preparing this report. The methods of study in appropriate cases included the following: vaginoscopy, digital-rectal palpation, vaginal cytosmears stained by the method of Papanicolaou or Shorr, vaginal cultures prepared and examined by standard laboratory techniques, suspension of vaginal fluid examined for fungi, trichomonads, and parasite ova, parafin swabs for the collection of perineal parasite ova, and roentgenologic vaginograms and examination under anesthesia. The diameter of the hymenal orifice and the length of the vagina have been determined in children a t the several periods of development by the use of rods of known length and diameter. The reaction of the vaginal fluid has been determined by the application of nitrazine paper inserted through a vaginoscope. The alterations that occur in the vagina and also in the other genitalia lend themselves to the following four divisions of the life span between birth and the menarche: (1) the neonatal period, (2) the period of early childhood, (3) the period of late childhood, and (4) the immediate premenarchal period. Each of these periods is marked by Characteristics that respond to hormonal stimulation. The appearance of these characteristics is usually correlated with somatic secondary sexual and chronological growth. They are not sharply demarcated one from the other; rather, onc period merges into the next.