Cigarette smoking and vaginal atrophy in postmenopausal women.

The atrophy of the vaginal epithelium was studied clinically and cytologically on vaginal smears of 1638 healthy postmenopausal female non smokers and 531 healthy postmenopausal smokers (over 30 years), with a mean age of 58 years. A very strong statistically significant difference (p < 0.0001) in the atrophical vaginal changes between smokers and nonsmokers to the disadvantage of the smokers. Also a very statistically significant association (p < 0.0001) was observed between the cytological expression of the vaginal atrophy and duration at menopause of the non-smokers but no association in the cases of the smokers. Another important result of this study was that the smokers women had an early menopause (p < 0.0001), on average by 2 years sooner (mean age 48.5 years) than non-smokers (mean age 50.5 years). These results suggest that cigarette smoking has an effect on the vaginal squamous epithelium, increasing the atrophical changes and causing early menopause by mechanisms, some of which remain unclear.