Before menopause, the vagina is well supplied with oestrogen. On closer look under a microscope, oestrogen-rich vaginal tissue shows a thick squamous stratified epithelium formed by many cell layers.What is known as the basal layer shows cells that are closely stacked together with evidence of continuous renewing of the stratified epithelium. There are more nuclei present in the cytoplasm and the presence of lots of papillae and elongated blood capillaries (Pic 1B).

This means the lining of a healthy vagina is therefore thicker, has more folds, is more moist, with better blood supply, allowing it to stretch with intercourse and childbirth without discomfort.

The Important of Oestrogen

Before menopause, the vagina is well supplied with oestrogen. Looking under the microscope, the oestrogen stimulated vaginal lining is thick and multilayered. It is designed to withstand friction. The depth of the layers show the high cell production rate. The cells themselves are rich with glycogen – this is a storage sugar in mammals (much like starch is in plants). The vaginal lining is the only one in the body with glycogen, the importance of which is described below (Pic 1A).

The deep layer is “wavy” which brings more blood vessels in contact with the lining which is important in producing moisture. The layer below the lining (the lamina propria) is rich in hyaluronic acid which holds 10,000 x its own weight in water. This is shown in the image below

This means the lining of a healthy vagina is therefore thicker, has more folds, is more moist, with better blood supply, allowing it to stretch with intercourse and childbirth without discomfort.

What Happens When Oestrogen Is Decreased?

After menopause, when levels of oestrogen are low or non-existent, the vaginal lining is significantly thinner, has fewer folds and less cell layers. Tissues have less papillae, less connective tissue, less glycogen and less blood vessels. This makes the vagina dry, prone to irritation, burning, itching, bacterial infections and generally less flexible with intercourse or vaginal penetration, causing pain with these activities.

A comparison of the vaginal lining pre and post menopause is shown below:

comparison-of-the-vaginal(Pic 1)

(A): Post-menopausal vaginal mucosa with atrophy caused by decreased oestrogen levels with reduced presence of vessels and a significantly thinner epithelium with lack of glycogen. (B): Vaginal mucosa in reproductive age; the mucosa is well supplied with blood and the epithelium consists of a larger number of cell layers, particularly rich in glycogen.

The Important of Glycogen

Among menstruating women, a low vaginal pH (or slightly acidic environment) is the result of oestrogen prompting the release of glycogen from the vaginal walls. Glycogen is broken down into glucose, which in turn is metabolized by vaginal lactobacilli (healthy bacteria) to produce lactic acid. This helps maintain the low pH, reinforcing the dominance of lactobacilli and other acid-loving bacteria, which repels unfriendly vaginal flora, in particular, Candida albicans (yeast infection or thrush), Escherichia coli (E. coli) and Gardnerella vaginalis (bacterial vaginitsi).

At menopause, the production of vaginal glycogen comes to a gradual and complete halt. As oestrogen levels decrease, glycogen is no longer secreted by the vaginal walls. The lack of glycogen and healthy lactobacilli creates a more alkaline environment, allowing for colonization of the vagina by fecal flora and other pathogens, resulting in a change in both quality and quantity of vaginal secretions.

How MonaLisa Touch restores Vaginal Hormones?

The MonaLisa Touch laser replicates the effect of oestrogen on the vaginal lining because the healing process uses the same chemical messenger (known as HSP47 – Heat Shock Protein 47). It stimulates more rapid turnover of the lining cells which become rich with glycogen again.

The deep layer becomes “wavy” once more and the lamina propria increase collagen and hyaluronic acid. There are more blood vessels in contact with the vaginal lining, which is essential in producing moisture. This eliminates the dry, burning, itching and lack of lubrication that many menopausal women face.

In turn, the natural breakdown of glycogen by vaginal lactobacilli (healthy bacteria) produces lactic acid, reduces pH (more acidic) and enhances the ability to fend off the unfriendly infections, discharge and odour.

The below image shows histological results for the vaginal lining of a patient 2 months after a single MonaLisa Touch treatment (with same enlargement):

enlargement(Pic 2)

Reference: Histologies courtesy of Prof. A. Calligaro - University of Pavia, Italy.
Reference: Courtesy of Prof. A. Calligaro. University of Pavia – Italy

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