Vaginal Dysplasia

Vaginal dysplasia is also called vaginal intraepithelial neoplasia, or VAIN. This “precancer” starts in the skin inside your vagina, when the cells undergo abnormal changes. If left untreated, VAIN can progress to vaginal cancer.

VAIN is less common than cervical or vulvar dysplasia, and it can be associated with these conditions. It’s classified as low grade or high grade based on how severe the abnormality is. It’s most common in women in their 40s through 60s.

Most women with VAIN have no symptoms, except perhaps abnormal vaginal bleeding, including bleeding between periods, bleeding after sex, and abnormal discharge.

VAIN diagnosis includes a pelvic exam with Pap test and a speculum and a colposcopy, which is a special lighted magnifying instrument. Most cases of VAIN are found during cervical cancer screening.

Risk Factors

You can reduce your risk of vaginal dysplasia by getting the HPV (human papillomavirus) vaccine, stopping smoking, and getting regular cervical cancer screening.

Risk factors for vaginal dysplasia are similar to those linked to cervical cancer and vulvar cancer. They include:

  • Exposure to the drug DES while in the mother’s womb in the 1950s
  • HPV infection
  • History of abnormal Pap smears
  • Smoking tobacco
  • History of cervical cancer or vaginal cancer
  • History of HIV (human immunodeficiency virus)

Treatment

You will work with your care team to determine your best course of treatment.

  • Low-grade VAIN often goes away without treatment. Your doctor may recommend just watching and waiting to make sure the affected areas don’t progress to high-grade VAIN or vaginal cancer. You may need exams with a Pap smear and colposcopy every few months. Your doctor may recommend treatment if it gets worse or doesn’t go away on its own.
  • High-grade VAIN requires immediate treatment because it’s less likely to go away on its own and more likely to become vaginal cancer.

You might need several types of treatment, including:

  • Laser ablation, which uses a laser beam to burn away abnormal tissue. This minor procedure is done in an outpatient center under anesthesia. You’ll probably go home the same day.
  • Topical therapy, which applies medication to the affected area for several weeks. These medications might be imiquimod, fluorouracil (5-FU), or estrogen cream.
  • Surgical excision, which involves cutting away the affected area with a margin of normal tissue around it. This procedure is done in an operating room under anesthesia. You might have surgery if other treatments don’t work or if your doctor is worried that you have vaginal cancer.
  • Radiation therapy, which uses high-energy beams targeted at the abnormal tissue to treat more serious cases of VAIN.

Follow-Up

Because you’re at risk for VAIN recurring throughout your lifetime, you will need close follow-up with a gynecologic oncologist or gynecologist who knows the skin changes associated with VAIN. You’ll typically have follow-up visits every six to 12 months after treatment.