Vaginal Intraepithelial Neoplasia

Vaginal intraepithelial neoplasia (VAIN) is a condition where there are abnormal cells in the vaginal lining. They have not started to grow into deeper vaginal tissues or spread to other places. Experts classify VAIN as either 1, 2, or 3. Each corresponds to the depth of these abnormal cells, 1 being only a third of the vaginal lining, 3, being the full thickness.

Last Updated: February 21, 2024

The number of cases of vaginal intraepithelial neoplasia (VAIN) is increasing every year, but the reported numbers are probably too low. Risk factors for VAIN include getting older, being infected with the human papillomavirus (HPV), having had a hysterectomy in the past, and having cervical intraepithelial neoplasia (CIN) or cervical cancer at the same time or in the past.

VAIN is most often caused by the human papillomavirus (HPV). Most VAIN 3 lesions are caused by at least one high-risk subtype of HPV. The most common high-risk subtypes are HPV 16 and 18.

The signs of VAIN can vary from one woman to another. Most women would not have any, but a few might experience spotting after sex or vaginal discharge. It is also possible that the aforementioned symptoms could indicate infection.

Doctors will perform a thorough physical examination where they inspect and palpate the vagina for lesions, color changes, ulceration, and thickness or irregularity of the vaginal wall. Most VAIN lesions are in the upper one-third of the vagina, and more than half of patients have more than one lesion.

Any patient with any of the above findings from a physical exam should have a thorough colposcopy of the whole vagina. Colposcopy will magnify the epithelial cells of the vagina, allowing for closer viewing of the abnormal cells. VAIN lesions will look like white, granular, raised or flat epithelium with sharply defined edges. They may also have areas of vascular punctuation.

Lastly, a definite way to tell if someone has VAIN is to do a biopsy and look for specific descriptions of VAIN. For example, VAIN is defined by the presence of squamous cell atypia without invasion.

Treatment

Most of the time, VAIN 1 does not need any treatment because abnormal cells go away after a while. While there are a number of ways to treat VAIN 2 or 3.

Laser treatment

A laser is a strong, hot beam of light that kills the abnormal cells by burning them away. Doctors use local anesthetic to numb the area.

Surgery

Doctors will recommend surgery if the abnormal cells have come back or if the womb has already been removed (hysterectomy). Surgeons will remove the abnormal cells and some healthy tissue around them, this is called "wide local excision." 

 

A surgeon might use a small loop of wire with an electric current to remove an area of abnormal cells. This is called LEEP or loop diathermy. They take out some healthy tissue around the abnormal cells to make it less likely that they will come back.

Creams 

Imiquimod cream is an antiviral drug that fights viruses and makes the immune system stronger so it can kill the abnormal cells. Doctors usually recommend this cream to younger people who have more than one area of VAIN.

The cream is usually put on the affected areas three to four times a week, and it can take up to six months to work. A common side effect of this treatment is that it makes the vagina swell up.

Doctors might also recommend a cream called fluorouracil that is used in chemotherapy. This needs to be used often and can be irritating to the vaginal skin.

A regular check-up to a gynecologist is especially recommended especially for women whose main source of income involves a high risk of acquiring sexually transmitted diseases.

References

Yu, D., Qu, P., & Liu, M. (2021). Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients. Journal of Obstetrics and Gynaecology Research, 47(5), 1624–1630. https://doi.org/10.1111/jog.14733

Cancer Research UK (2022). Vaginal intraepithelial neoplasia (VAIN). Retrieved November 21, 2022, from https://www.cancerresearchuk.org/about-cancer/vaginal-cancer/vain#:~:text=Vaginal%20intraepithelial%20neoplasia%20(VAIN)%20means,vagina%20or%20spread%20anywhere%20else.

Christine H Holschneider, C., Berek, J. (2022). Vaginal intraepithelial neoplasia.  UpToDate. Retrieved November 21, 2022 from https://www.uptodate.com/contents/vaginal-intraepithelial-neoplasia?

Last Updated: February 21, 2024