Genitourinary Syndrome of Menopause (GSM)- Pap Test and Gram Findings

The loss of ovarian function, prematurely or due to menopause, causes a decrease of the vaginal epithelium trophy. However, with the end of the menstrual cycle and the consequent hypoestrogenism, the epithelial thickness also decreases, with only the parabasal and basal layers remaining with low glycogen reserves. A thinner epithelial thickness associated with a pH greater than 4.5 and a microbiota without protective bacteria (Lactobacillus sp) can lead to an inflammatory condition not necessarily related to the action of a pathogen but mainly the atrophy itself. Atrophic vaginitis is often confused with genitourinary syndrome of menopause (GSM). Laboratory findings do not necessarily coincide with symptoms but could help in diagnosing. Examinations such as bacterioscopy of vaginal smear (Gram) and cytology (Pap test or cytology in liquid medium) have findings that may suggest a picture of intense hypoestrogenism. However, the clinical-laboratory correlation is essential.