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Background: Periodic, routine Papanicolaou smears of cells from the vagina are commonly examined in women who have undergone a hysterectomy for benign gynecologic disease. The benefits of this method of screening are not known., Methods: We analyzed Papanicolaou smears obtained from the vaginal apex (cuff) in 6265 women at Charity Hospital in New Orleans between January 1, 1992, and December 31, 1994. Of the 10,595 vaginal smears, an estimated 9610 were obtained during follow-up examinations of 5682 women who had undergone hysterectomy for benign gynecologic disease., Results: Among these 9610 vaginal smears, 104, from 79 women, were abnormal. The abnormal smears were categorized according to the findings, as follows: atypical squamous cells of undetermined significance, 52 (0.5 percent of all smears); low-grade squamous intraepithelial lesion, 44 (0.5 percent); high-grade squamous intraepithelial lesion, 6 (0.1 percent); and squamous-cell carcinoma, 2 (0.02 percent). In five women, biopsies revealed vaginal intraepithelial neoplasia type I or II; there were no biopsy-proved cases of vaginal cancer. The probability of an abnormal Papanicolaou smear in this group of women was 1.1 percent, and the positive predictive value of the Papanicolaou test for detecting vaginal cancer was 0 percent (95 percent confidence interval, 0 to 33 percent)., Conclusions: The prevalence of abnormal findings on cytopathological examination of vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease is extremely low.

Background: Sarcoidosis is a multisystem disease that rarely affects the female genital tract. It has been found the endometrium but has never been reported as a cause of postmenopausal bleeding., Case: A 53-year-old, postmenopausal women presented complaining of a single, five-day episode of vaginal bleeding. An endometrial biopsy revealed many noncaseating granulomas with sarcoid-type asteroid bodies. The remainder of the work-up was negative, and the symptoms spontaneously resolved., Conclusion: Sarcoidosis can present as a focal disease and should be considered in the differential diagnosis of granulomatous disease of the endometrium.