Vaginal intraepithelial neoplasia, also known as VAIN, is a condition involving cell changes in the vagina. It is sometimes referred to as carcinoma in situ. VAIN is not cancer, but there is a chance it may develop into cancer if left untreated.
VAIN is being diagnosed more often, probably because doctors are looking for it rather than because the incidence is actually increasing in women.
In a proportion of women, VAIN can progress to cancer. The likelihood partly depends on what a biopsy looks like down the microscope and whether the condition is treated.
VAIN rarely causes symptoms and is usually detected because a woman is considered potentially at risk. VAIN is most often diagnosed in middle-aged women, and seems to go along with similar abnormalities on the cervix and externally on the vulva.
Who is at risk for VAIN?
Since VAIN is relatively uncommon, not as much is known about it as about its sister conditions on the vulva and cervix. However, it appears to be more likely in women who:
- have had human papillomavirus (HPV) infection
- have suppressed immune systems
- have had surgery for cervical precancerous lesions
- have had radiation therapy for uterine cancer
- have had vulval intraepithelial neoplasia (VIN)
- were exposed as a fetus to a hormone medication called diethylstilboestrol (DES)
- have had a hysterectomy for any reason (no-one is sure why this is so, or whether it is a real risk factor – it may just be that such women are more closely followed up and tested)
- have had an abnormal Pap smear but the cervix is normal.
Symptoms of VAIN
There are usually no symptoms, but women can have abnormal vaginal bleeding, pain during intercourse and/or bleeding after intercourse.
When the doctor examines the woman, it is usually hard to see any abnormalities on the lining of the vagina. This is made harder by the fact that VAIN is often high up in the vagina and in multiple places (multifocal).
How VAIN is diagnosed
If there is a suspicion of VAIN (see above risk factors), gynaecologists may use an instrument called a colposcope.
A colposcope looks like a pair of binoculars sitting on a large stand. It does not enter the body – the doctor inserts an instrument called a speculum into your vagina and then views a magnified picture of the vagina, cervix and vulva through the colposcope.
This procedure can help identify where abnormal or changed cells are located and what they look like. The doctor will probably take a tissue sample (biopsy) during the procedure.
Pathologists assess the seriousness of VAIN in an individual woman from the biopsy. Among other things, they look at how superficial or deep the abnormal cells have spread, and grade the risk of cancer developing.
Treatment of VAIN
Treatment will depend to some extent on whether a woman is considered at high risk of vaginal cancer.
VAIN that has not spread far may not require any treatment. A key thing the gynaecologist needs to be sure about is that there isn’t a malignancy lurking within the VAIN tissue.
Removing the abnormal tissue surgically is one option, but involves some risk of complications and can affect sexual function.
Destroying the VAIN with laser treatment or heat treatment (loop diathermy) has fewer side effects. However, if the VAIN is high risk, surgery may be safer and give greater peace of mind.
Anti-cancer chemotherapy creams are also sometimes prescribed. Although these are effective, they can cause discomfort and inflammation.
Occasionally, VAIN is so widespread or hard to treat that more extensive surgery or radiotherapy is recommended.
Stopping smoking is a good idea. Some experts argue that, if a woman has had a hysterectomy for any reason, she should have Pap smears of the vagina regularly to check for abnormal cells.