Rate of Squamous Cell Turnover: The vaginal epithelium is in a constant state of turn-over or shedding. The full layer turns over in about 30 days from the basal layer to the top layer. The fully maturated cells on top are being exfoliated into the vagina where they provide nutrition for the microflora. This is how the vaginal ecosystem works. The cells and fluids in the vagina provide the nutrients for the lactobacilli. Then lactobacilli secrete substances that suppress the 30+ bad bacteria in the vagina to a degree where they cause no harm. With the lack of sufficient nutrients, the concentration of fully maturated squamous cells will be too low. Also, certain inflammatory conditions in the vagina will cause the epithelium to turn over faster resulting in a higher proportion of Basal, Parabasal and Intermediate Cells. Once this process has been going on for some time, then there are fewer cells that are fully maturated and being exfoliated into vaginal secretions. These are patterns of vaginal constituents that are detected as part of the Vaginal Fluid Analysis (VFA Test).

Tissue Response to AVMF: In women who have developed AVMF patterns, the vaginal secretions can be irritative rather than neutral to surrounding tissues. These secretions do not tend to bother the upper two-thirds of the vagina on account of the relative low innervation or concentration of nerve endings found there. It’s the lower third of the vagina and particularly the vestibule where the epithelium often gets sensitized resulting in variable degrees of burning and itching depending on the woman’s innate tissue propensities. In other women, the AVMF also can cause discharge and or odor without genitalia symptoms.

The Vestibule: Is an area approximately 1-1.5cm wide encircling the opening of the vagina beginning just inside the labia minora or inner lips and extending up to to the level of the hymenal ring. The vestibule is made of endodermal embryologic origin which is wedged in between ectodermal epithelium. It is the vestibule that has the propensity of getting adversely stimulated by aberrant vaginal secretions. On the inside of the labia minora or small lip there is an invisible line to the human eye, known as the vestibular line of Hart, which demarcates the beginning of the vestibule being derived of endodermal or urogenital sinus origin.  (Kurman RJ, Ronnett BM, Sherman ME, Wilkinson EJ. Anatomy of the lower genital tract. Vol 4 Silver Springs: Armed Forces Institute of Pathology; 2010. This line can be demarcated by applying an iodine based Monsel’s solution. It stains the endoderm but not the ectoderm. Symptoms of burning and itching arise from the endoderm. Odor and discharge arise from the direct effect of the AVMF itself.

Hart’s line is visible over a portion of lower left vestibule.

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