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Luminescent Phenomena of the External Female Genitalia
Luminescent Phenomena of the External Female Genitalia
l
r
P. A. Macdonald, Ph.D., • and M. Sydney Margolese, M.D.
have made a study of the luminescence of the vulva in normal and abnormal physiologic states. It has been found that luminescence appears prepuberally, is always present thereafter, and varies in character with cyclic fluctuations of the ovarian hormone levels. It would appear that abnormal physiologic conditions associated with fluctuating hormone levels may be, to some extent at least, analyzed by luminescent examination.
THE AUTHORS
I
:)
PHENOMENA OF LUMINESCENCE In making a visual study of luminescent phenomena, there are a number of fundamental physical facts that must constantly be borne in mind. The absorption of radiant energy is sometimes accompanied by its reemission at wave frequencies characteristic of the absorbing substance and this phenomenon is defined as luminescence. A study of such emitted radiation is then of potential value in classifying and specifying the absorber. If re-emission ceases with excitation, the substance is said to fluoresce, but if the emission continues after the extinction of the -incident radiation, the substance is said to phosphoresce. While phosphorescence may continue for hours, or even weeks, it may also last a small fraction of a second after extinction of the exciting radiation. In the latter instance, fluorescence and From the Radiation Laboratories, the Manitoba Cancer Institute,- Winnipeg, Canada. . The authors would like to record their grateful thanks to the Ciba Company, Montreal, Canada, and Ciba Pharmaceutical Products, Inc., Summit, N. J., for very material assistance in supplying the color reproductions used in this communication. 26
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Vol. I, No. I, 1950]
LUMINESCENT PHENOMENA
27
phosphorescence may be differentiated by exciting and viewing the emitting substance through a rotating sector in such a manner that excitation and examination follow each other in rapid intermittent succession. The emission spectra of luminescent bodies differs from the emission spectra of the elements in that luminescence is characterized by bands rather than strictly monochromatic lines. From the viewpoint of practical spectra analysis, this is unfortunate, as the width of the band reduces the specificity of the analysis. Band frequencies are, however, characteristic of the emitting substance and under some circumstances may be utilized both as a qualitative and quantitative method of estimation. Additional information about the characteristics of the emitting substance may be obtained by determining whether the luminescence is fluorescent or phosphorescent in nature. While luminescence is commonly observed by the eye, it should be appreciated that energy may be emitted in other than the visual region. Thus, complete analysis of luminescent radiation can only be done spectroscopically. Luminescence is most frequently excited by radiations lying in the ultraviolet region. The ideal source of exciting energy would be a continuous ultraviolet source and a high-power ultraviolet monochrometer permitting selection of monochromatic exciting frequencies. The cost and bulk of such equipment renders it impracticable for all but the most refined investigations. The source most commonly employed for visual studies is a mercury vapor lamp excited by an electrical discharge and equipped with optical filters designed to reduce the intensity of the visible radiation accompanying the production of the ultraviolet. A number of commercial units of this type are on the market, but all these commercial sources emit some radiation in the visible region, due to the limitations of the filters. The usual commercial filters are pigmented glasses and it is extremely difficult to secure satisfactory pigments which are transparent in the ultraviolet and fully opaque through the visible region. The most effective filter is Coming No. 5860 which is generally taken as having a cut-off at 3865 N. However, the absorption curves for all such filters are asymptotic to the wave length axis so that high intensity light sources emitting radiation slightly beyond 3865 N would transmit some of this energy. It so happens that the spectra of most mercury lamps have strong lines at 3906 Ao and 3984 AO, with the result that mercury arcs using these filters deliver radiation
28
MACDONALD & MARGOLESE
[Fertility & Sterility
in this region, a region in which the average eye can respond since the lower limit of visibility of the average eye is usually taken as 3970 N. There has recently come on the market an entirely different type of light filter operating on interference principles. These filters are highly selective in the immediate neighborhood of the transmission bands for which they are designed and hence, as far as purity is concerned, are excellent when used in conjunction with a pigmented filter such as Corning 5860. Unfortunately, the aperture of the interference filters available on the market is somewhat smaller than the dimensional requirements of a satisfactory high-pressure mercury arc, so that the resulting loss of intensity vitiates against their present day use. To make visual studies of luminescent phenomena, it is not only important to use a light source with the highest possible ratio of ultraviolet to visible light, but precautions must be taken against the production of visible light in the eye itself due to fluorescence of the lens and retina under ultraviolet stimulation. An ideal arrangement to prevent this would be to wear a second filter over the eye, transmitting only the visible spectrum. The authors have attempted to prepare filters of this type but none have been satisfactory, for all the filters themselves have been found to fluoresce under ultraviolet light thus leaving no net gain. Pending the development of such a filter, adequate precautions must be taken against ultraviolet radiation being reflected into the eye, for fluorescence produced in this manner may be sufficiently intense to mask the luminescent light from the object under investigation. For the purposes of the present communication, this condition would certainly cause misrepresentation of the colors of the luminescent spectra to be described. Turning from considerations of the source of light to the properties of the eye as a receiver, critical visual examination of luminescent spectra may be made only under closely defined conditions due to the limitations of the eye both as a receiver and as an analyzer. The greatest limitation is due to the fact that similar color sensations result from various combinations of different wave lengths, for example, all wave lengths in the visible spectrum above 6500 Ao give the same red sensation. Again, the two monochromatic radiations, 6700 Nand 5500 N, may be mixed with different relative intensities to give the same sensation that results from any single monochromatic radiation lying in the spectral region between them. Further, single blue and single red monochromatic radiations may combine in different
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II
Vol. 1, No.1, 1950]
LUMINESCENT PHENOMENA
29
relative intensities to yield approximately any spectral color. Under this latter condition, a mixture of two different substances, one luminescing red and the other blue would give rise to a whole series of spectral colors depending upon their relative concentrations. Thus, the different spectral colors do not necessarily mean different substances, but could be due to different relative concentrations of the same substances. The limitations of visual analysis also apply to color photography as commonly practiced, for color film, like the eye, is sensitized for specific spectral regions and for a specific, carefully defined white light source having a definite color distribution. Ordinary color photography cannot then be used for recording luminescent phenomena in their true colors as these colors arise from bands and not the continuous spectra to which the film has been designed to respond. It will be obvious that conclusions following a visual examination may only be drawn with the greatest reservation unless preceded by spectrographic analysis. However, within the narrow limits of its utility, visual examination offers the possibility of providing a powerful tool for the recognition, in situ, of substances in the living system, provided the limitations and sources of error are constantly borne in mind. PROCEDURE In the present study, the authors have utilized a General Electric CH4 mercury arc spot lamp and 16 millimeters of No. 5874 Corning filter. The filter is not as selective as the previous mentioned No. 5860, but its greater transparency in the ultraviolet more than offsets this disadvantage. This light source passes an appreciable amount of radiation giving a blue visual sensation which approximates one of the luminescent colors noted. Hence, it is necessary at the outset to become familiar with this extraneous radiation. This can best be done by examining the skin of the arm, as this does not appreciably luminesce. Precautions must also be taken to determine the presence of foreign substances which themselves may give rise to luminescent phenomena. This is particularly true of certain deodorants, toilet paper, Vaseline, and various face and bath powders. Again biologic material may accumulate, especially in the folds of the clitoris, and give rise to a red luminescence. Failure to remove this substance may give the erroneous impression of the existence of a red luminescence in this area. Luminescent examination is done in total darkness with the eye dark-
30
MACDONALD & MARGO LESE
[Fertility & Sterility
L
0,
adapted. The patient is in the lithotomy position with the lamp about 6 inches from the vulva. In the present study, a series of crayons were selected to match the noted luminescence and records made by crayon sketches on a previously prepared diagram of the vulva. The records then are, at the best, only an approximation of the existing colors.
GENERAL OBSERVATIONS Luminescence of the vulva was observed to occur in varying color and intensity with differing physiologic states. During the menstrual cycle, the luminescence varies with the phase of the cycle. From one day premenstrually, to sometime during the first day of the cycle, a bright red appears. This luminescence persists during the period through which the estrogenic hormone falls and remains at a low level. As the estrogen concentration increases, the area of red luminescence decreases, though the intensity of any given area may remain the same, or may decrease. In the normal cycle the red entirely disappears several days postmenstrually, although it usually persists in slight degree sometime after the cessation of the macroscopic bleeding. The red usually disappears from the periphery first, then centrally, and lastly from the clitoral area. Concomitant with the disappearance of the red, the central area becomes purple and the peripheral area green. vVith the increase in estrogen from the postmenstrual period to mid-cycle, the area of purple luminescence spreads and appears to increase in intensity. This trend increases during the luteal phase so that frequently the entire vulvar area is purple. During this phase the luteal hormone has been added to the estrogenic hormone. The purple may persist in this manner during the premenstrual phase, and more commonly it may decrease slightly in area with the reappearance of the green luminescence. This phase corresponds to decreasing ovarian hormone levels. Red then appears initially, usually in small patches. During the time of its appearance, the red area is variable, although it appears to be proportional to the extent of bleeding. It may vary from a few small patches to a reddening of the entire vulva. Those areas not covered by the red are green and purple in the same distribution as immediately prior to the appearance of the red. These phenomena have been observed with consistent regularity in over one hundred cycles examined. A characteristic normal is reproduced in Plate 1, correlated with basal temperatures.
I
Vol. 1, No.1, 1950]
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LUMINESCENT PHENOMENA
31
Both vaginal smears and vaginal temperatures clearly indicate that during the follicular phase the increasing purple area is indicative of an increasing estrogen metabolism. The increase in intensity of the purple during the luteal phase shows that it is indicative of progesterone metabolism. The green appears to be a background color upon which the purple is superimposed. Thus when either estrogen and/or progesterone are sufficiently low in concentration, there will be insufficient purple to cover the background so that it becomes ,apparent. Since, as will be shown, the green may appear under all other conditions except early childhood, it may be concluded that this color represents sex hormone metabolism of a noncyclic character. Red, on the other hand, only appears when there is a cyclic fluctuation of the ovarian hormone levels. It never appears prior to the menarche nor after the final cessation of bleeding. These conclusions are strengthened by other studies. Plate 2 shows the changes produced by the cyclic administration and withdrawal, to an amenorrheic woman, of estrogen and progesterone. The initial luminescence was chiefly green. The administration of estrogen caused the appearance .of a moderate degree of purple, which increased in area and intensity following the simultaneous administration of estrogen and progesterone. Withdrawal of both hormones induced bleeding with a concurrent red luminescence. Plate 3 shows the appearance of vulvar luminescence during various stages of childhood and pubescence. This luminescence appears to indicate the initiation of sex hormone metabolism, preceding the appearance of secondary sex characteristics. This further suggests that the purple reflects the presence of biologically significant amounts of estrogen and/or progesterone. As ovarian involution is a gradual process extending over a period of time, one would anticipate finding variations in the luminescent phenomena during this period. Such variations are demonstrated in figure A, Plate IV, and they broadly fall into two groups. One of these types appears as chiefly uniform green. The other has a green background with purple unevenly superimposed. In both cases the administration of estrogen enhances the purple, as is illustrated in Figure B, Plate 4. This constitutes a method of determining the efficacy of estrogen therapy. A further application is the differentiation of endocrine from nonendocrine
32
MACDONALD & MARGOLESE
[Fertility & Sterility
I.
'/
postmenopausal bleeding. Bleeding in the presence of red luminescence, as shown in Figure C, Plate 4, is indicative of an endocrine factor. Bleeding without red luminescence indicates a nonendocrine cause. Vulvar luminescence during normal and abnormal pregnancies has been studied and will be the subject of a subsequent report. It will discuss the possibility of the control of threatened abortion due to endocrine deviations.
CONCLUSIONS The data presented in this communication show that the external female genitalia luminesce under ultraviolet stimulation, and that this luminescence exhibits spectral colors which vary in specific relation to the known variations of the sex hormone levels. Before these phenomena can be completely interpreted the study must be expanded on a quantitative basis using physical equipment to determine both the wave lengths and intensities of the radiation present. However, the present studies, even though they utilize visual analysis, are of considerable practical importance provided, in carrying them out, the limitations of the eye as a receptor and analyzer are recognized, and provided that due allowance is made for estimating the reflected light in the visibJe region, which has its origin in the ultraviolet source. Since the observed phenomena can be correlated with the metabolic levels of the sex hormones, the procedure is of value in determining hormone deviations at the menarche, during the menacme, during pregnancy, and at the menopause. Subsequent communications will establish the utility of the method in evaluating disturbances of sex hormone metabolism causing menstrual abnormalities, in the recognition of endocrine deviations which are potentially abortive, and in the differentiation of end~crine and nonendrocrine bleeding.
r
l
t I
I
l
SUMMARY It is shown that the external female genitalia exhibit vari-colored luminescence under ultraviolet light and that the color variations may be correlated with sex hormone metabolism. The practical technic for sex hormone assay and its applications to clinical diagnosis are discussed.
I
I
l
r
P. A. Macdonald, Ph.D., • and M. Sydney Margolese, M.D.
have made a study of the luminescence of the vulva in normal and abnormal physiologic states. It has been found that luminescence appears prepuberally, is always present thereafter, and varies in character with cyclic fluctuations of the ovarian hormone levels. It would appear that abnormal physiologic conditions associated with fluctuating hormone levels may be, to some extent at least, analyzed by luminescent examination.
THE AUTHORS
I
:)
PHENOMENA OF LUMINESCENCE In making a visual study of luminescent phenomena, there are a number of fundamental physical facts that must constantly be borne in mind. The absorption of radiant energy is sometimes accompanied by its reemission at wave frequencies characteristic of the absorbing substance and this phenomenon is defined as luminescence. A study of such emitted radiation is then of potential value in classifying and specifying the absorber. If re-emission ceases with excitation, the substance is said to fluoresce, but if the emission continues after the extinction of the -incident radiation, the substance is said to phosphoresce. While phosphorescence may continue for hours, or even weeks, it may also last a small fraction of a second after extinction of the exciting radiation. In the latter instance, fluorescence and From the Radiation Laboratories, the Manitoba Cancer Institute,- Winnipeg, Canada. . The authors would like to record their grateful thanks to the Ciba Company, Montreal, Canada, and Ciba Pharmaceutical Products, Inc., Summit, N. J., for very material assistance in supplying the color reproductions used in this communication. 26
t )
(
( f
I r
l f
I( I
I
r
r
'''' \
Vol. I, No. I, 1950]
LUMINESCENT PHENOMENA
27
phosphorescence may be differentiated by exciting and viewing the emitting substance through a rotating sector in such a manner that excitation and examination follow each other in rapid intermittent succession. The emission spectra of luminescent bodies differs from the emission spectra of the elements in that luminescence is characterized by bands rather than strictly monochromatic lines. From the viewpoint of practical spectra analysis, this is unfortunate, as the width of the band reduces the specificity of the analysis. Band frequencies are, however, characteristic of the emitting substance and under some circumstances may be utilized both as a qualitative and quantitative method of estimation. Additional information about the characteristics of the emitting substance may be obtained by determining whether the luminescence is fluorescent or phosphorescent in nature. While luminescence is commonly observed by the eye, it should be appreciated that energy may be emitted in other than the visual region. Thus, complete analysis of luminescent radiation can only be done spectroscopically. Luminescence is most frequently excited by radiations lying in the ultraviolet region. The ideal source of exciting energy would be a continuous ultraviolet source and a high-power ultraviolet monochrometer permitting selection of monochromatic exciting frequencies. The cost and bulk of such equipment renders it impracticable for all but the most refined investigations. The source most commonly employed for visual studies is a mercury vapor lamp excited by an electrical discharge and equipped with optical filters designed to reduce the intensity of the visible radiation accompanying the production of the ultraviolet. A number of commercial units of this type are on the market, but all these commercial sources emit some radiation in the visible region, due to the limitations of the filters. The usual commercial filters are pigmented glasses and it is extremely difficult to secure satisfactory pigments which are transparent in the ultraviolet and fully opaque through the visible region. The most effective filter is Coming No. 5860 which is generally taken as having a cut-off at 3865 N. However, the absorption curves for all such filters are asymptotic to the wave length axis so that high intensity light sources emitting radiation slightly beyond 3865 N would transmit some of this energy. It so happens that the spectra of most mercury lamps have strong lines at 3906 Ao and 3984 AO, with the result that mercury arcs using these filters deliver radiation
28
MACDONALD & MARGOLESE
[Fertility & Sterility
in this region, a region in which the average eye can respond since the lower limit of visibility of the average eye is usually taken as 3970 N. There has recently come on the market an entirely different type of light filter operating on interference principles. These filters are highly selective in the immediate neighborhood of the transmission bands for which they are designed and hence, as far as purity is concerned, are excellent when used in conjunction with a pigmented filter such as Corning 5860. Unfortunately, the aperture of the interference filters available on the market is somewhat smaller than the dimensional requirements of a satisfactory high-pressure mercury arc, so that the resulting loss of intensity vitiates against their present day use. To make visual studies of luminescent phenomena, it is not only important to use a light source with the highest possible ratio of ultraviolet to visible light, but precautions must be taken against the production of visible light in the eye itself due to fluorescence of the lens and retina under ultraviolet stimulation. An ideal arrangement to prevent this would be to wear a second filter over the eye, transmitting only the visible spectrum. The authors have attempted to prepare filters of this type but none have been satisfactory, for all the filters themselves have been found to fluoresce under ultraviolet light thus leaving no net gain. Pending the development of such a filter, adequate precautions must be taken against ultraviolet radiation being reflected into the eye, for fluorescence produced in this manner may be sufficiently intense to mask the luminescent light from the object under investigation. For the purposes of the present communication, this condition would certainly cause misrepresentation of the colors of the luminescent spectra to be described. Turning from considerations of the source of light to the properties of the eye as a receiver, critical visual examination of luminescent spectra may be made only under closely defined conditions due to the limitations of the eye both as a receiver and as an analyzer. The greatest limitation is due to the fact that similar color sensations result from various combinations of different wave lengths, for example, all wave lengths in the visible spectrum above 6500 Ao give the same red sensation. Again, the two monochromatic radiations, 6700 Nand 5500 N, may be mixed with different relative intensities to give the same sensation that results from any single monochromatic radiation lying in the spectral region between them. Further, single blue and single red monochromatic radiations may combine in different
...I. ;
,t I
l
r I I
i
(~
,~
I ~
II
Vol. 1, No.1, 1950]
LUMINESCENT PHENOMENA
29
relative intensities to yield approximately any spectral color. Under this latter condition, a mixture of two different substances, one luminescing red and the other blue would give rise to a whole series of spectral colors depending upon their relative concentrations. Thus, the different spectral colors do not necessarily mean different substances, but could be due to different relative concentrations of the same substances. The limitations of visual analysis also apply to color photography as commonly practiced, for color film, like the eye, is sensitized for specific spectral regions and for a specific, carefully defined white light source having a definite color distribution. Ordinary color photography cannot then be used for recording luminescent phenomena in their true colors as these colors arise from bands and not the continuous spectra to which the film has been designed to respond. It will be obvious that conclusions following a visual examination may only be drawn with the greatest reservation unless preceded by spectrographic analysis. However, within the narrow limits of its utility, visual examination offers the possibility of providing a powerful tool for the recognition, in situ, of substances in the living system, provided the limitations and sources of error are constantly borne in mind. PROCEDURE In the present study, the authors have utilized a General Electric CH4 mercury arc spot lamp and 16 millimeters of No. 5874 Corning filter. The filter is not as selective as the previous mentioned No. 5860, but its greater transparency in the ultraviolet more than offsets this disadvantage. This light source passes an appreciable amount of radiation giving a blue visual sensation which approximates one of the luminescent colors noted. Hence, it is necessary at the outset to become familiar with this extraneous radiation. This can best be done by examining the skin of the arm, as this does not appreciably luminesce. Precautions must also be taken to determine the presence of foreign substances which themselves may give rise to luminescent phenomena. This is particularly true of certain deodorants, toilet paper, Vaseline, and various face and bath powders. Again biologic material may accumulate, especially in the folds of the clitoris, and give rise to a red luminescence. Failure to remove this substance may give the erroneous impression of the existence of a red luminescence in this area. Luminescent examination is done in total darkness with the eye dark-
30
MACDONALD & MARGO LESE
[Fertility & Sterility
L
0,
adapted. The patient is in the lithotomy position with the lamp about 6 inches from the vulva. In the present study, a series of crayons were selected to match the noted luminescence and records made by crayon sketches on a previously prepared diagram of the vulva. The records then are, at the best, only an approximation of the existing colors.
GENERAL OBSERVATIONS Luminescence of the vulva was observed to occur in varying color and intensity with differing physiologic states. During the menstrual cycle, the luminescence varies with the phase of the cycle. From one day premenstrually, to sometime during the first day of the cycle, a bright red appears. This luminescence persists during the period through which the estrogenic hormone falls and remains at a low level. As the estrogen concentration increases, the area of red luminescence decreases, though the intensity of any given area may remain the same, or may decrease. In the normal cycle the red entirely disappears several days postmenstrually, although it usually persists in slight degree sometime after the cessation of the macroscopic bleeding. The red usually disappears from the periphery first, then centrally, and lastly from the clitoral area. Concomitant with the disappearance of the red, the central area becomes purple and the peripheral area green. vVith the increase in estrogen from the postmenstrual period to mid-cycle, the area of purple luminescence spreads and appears to increase in intensity. This trend increases during the luteal phase so that frequently the entire vulvar area is purple. During this phase the luteal hormone has been added to the estrogenic hormone. The purple may persist in this manner during the premenstrual phase, and more commonly it may decrease slightly in area with the reappearance of the green luminescence. This phase corresponds to decreasing ovarian hormone levels. Red then appears initially, usually in small patches. During the time of its appearance, the red area is variable, although it appears to be proportional to the extent of bleeding. It may vary from a few small patches to a reddening of the entire vulva. Those areas not covered by the red are green and purple in the same distribution as immediately prior to the appearance of the red. These phenomena have been observed with consistent regularity in over one hundred cycles examined. A characteristic normal is reproduced in Plate 1, correlated with basal temperatures.
I
Vol. 1, No.1, 1950]
~.
t ',"
! (
i'
r
...~
LUMINESCENT PHENOMENA
31
Both vaginal smears and vaginal temperatures clearly indicate that during the follicular phase the increasing purple area is indicative of an increasing estrogen metabolism. The increase in intensity of the purple during the luteal phase shows that it is indicative of progesterone metabolism. The green appears to be a background color upon which the purple is superimposed. Thus when either estrogen and/or progesterone are sufficiently low in concentration, there will be insufficient purple to cover the background so that it becomes ,apparent. Since, as will be shown, the green may appear under all other conditions except early childhood, it may be concluded that this color represents sex hormone metabolism of a noncyclic character. Red, on the other hand, only appears when there is a cyclic fluctuation of the ovarian hormone levels. It never appears prior to the menarche nor after the final cessation of bleeding. These conclusions are strengthened by other studies. Plate 2 shows the changes produced by the cyclic administration and withdrawal, to an amenorrheic woman, of estrogen and progesterone. The initial luminescence was chiefly green. The administration of estrogen caused the appearance .of a moderate degree of purple, which increased in area and intensity following the simultaneous administration of estrogen and progesterone. Withdrawal of both hormones induced bleeding with a concurrent red luminescence. Plate 3 shows the appearance of vulvar luminescence during various stages of childhood and pubescence. This luminescence appears to indicate the initiation of sex hormone metabolism, preceding the appearance of secondary sex characteristics. This further suggests that the purple reflects the presence of biologically significant amounts of estrogen and/or progesterone. As ovarian involution is a gradual process extending over a period of time, one would anticipate finding variations in the luminescent phenomena during this period. Such variations are demonstrated in figure A, Plate IV, and they broadly fall into two groups. One of these types appears as chiefly uniform green. The other has a green background with purple unevenly superimposed. In both cases the administration of estrogen enhances the purple, as is illustrated in Figure B, Plate 4. This constitutes a method of determining the efficacy of estrogen therapy. A further application is the differentiation of endocrine from nonendocrine
32
MACDONALD & MARGOLESE
[Fertility & Sterility
I.
'/
postmenopausal bleeding. Bleeding in the presence of red luminescence, as shown in Figure C, Plate 4, is indicative of an endocrine factor. Bleeding without red luminescence indicates a nonendocrine cause. Vulvar luminescence during normal and abnormal pregnancies has been studied and will be the subject of a subsequent report. It will discuss the possibility of the control of threatened abortion due to endocrine deviations.
CONCLUSIONS The data presented in this communication show that the external female genitalia luminesce under ultraviolet stimulation, and that this luminescence exhibits spectral colors which vary in specific relation to the known variations of the sex hormone levels. Before these phenomena can be completely interpreted the study must be expanded on a quantitative basis using physical equipment to determine both the wave lengths and intensities of the radiation present. However, the present studies, even though they utilize visual analysis, are of considerable practical importance provided, in carrying them out, the limitations of the eye as a receptor and analyzer are recognized, and provided that due allowance is made for estimating the reflected light in the visibJe region, which has its origin in the ultraviolet source. Since the observed phenomena can be correlated with the metabolic levels of the sex hormones, the procedure is of value in determining hormone deviations at the menarche, during the menacme, during pregnancy, and at the menopause. Subsequent communications will establish the utility of the method in evaluating disturbances of sex hormone metabolism causing menstrual abnormalities, in the recognition of endocrine deviations which are potentially abortive, and in the differentiation of end~crine and nonendrocrine bleeding.
r
l
t I
I
l
SUMMARY It is shown that the external female genitalia exhibit vari-colored luminescence under ultraviolet light and that the color variations may be correlated with sex hormone metabolism. The practical technic for sex hormone assay and its applications to clinical diagnosis are discussed.
I
I