Vaginal intraepithelial neoplasia, also known as VAIN, is a condition that causes pre-cancerous changes in the cells of the vaginal tissue. Although many cases of VAIN resolve on their own, the changes may become cancerous after several years of no treatment.
VAIN is most commonly found in the upper third portion of the vaginal canal (the area closest to the cervix), but it can also be multi-focal, which means that it can occur in several areas simultaneously. Sometimes VAIN is accompanied by pre-cancerous changes in the vulva, cervix, anus, and other pelvic tissue. Women over age 50 are at the highest risk for VAIN, but the condition can develop in women of any age.
VAIN is subdivided into three grades, indicating how much of the surface layer of the vagina has been affected.
- VAIN 1 – One-third of the depth of the surface layer is affected
- VAIN 2 – Two-thirds of the depth of the surface layer is affected
- VAIN 3 – The entire surface layer is affected
Causes of VAIN
VAIN is a complicated condition that likely has multiple, interrelated causes. It may be impossible to pin down the exact cause of a specific case of VAIN. However, experts believe that most cases of VAIN are linked to HPV, immunosuppression, and previous cancer or pre-cancerous conditions.
The human papillomavirus (HPV) is one of the most common sexually-transmitted infections. It’s very easy to spread through skin-to-skin contact with an infected person, and because infections are often asymptomatic, many people aren’t aware that they carry the virus.
There are over 100 strains of HPV, but only two strains are associated with VAIN: type 16 and type 18. A vaccine is available to protect against these dangerous strains. It is typically recommended for young girls ages 11-12 up to the age of 26.
When the immune system is suppressed, it has a much harder time fighting off infections, such as HPV, that might cause VAIN and other pre-cancerous conditions. These qualities can negatively affect a woman’s immune system:
- Genetic disorders of the immune system
- Some medications, such as those taken after an organ transplant
- Bone marrow disorders
- Blood disorders
Cancer or precancerous changes
Women who have previously experienced pre-cancerous changes or cancer of the vagina, cervix, vulva, or other reproductive and pelvic tissue are at a heightened risk for developing VAIN. Even women who have had a hysterectomy to treat cancer are at risk. Women who have received radiation as treatment for cancer in the pelvis may also have a slightly higher chance of developing VAIN.
Symptoms of VAIN
Patients with VAIN usually exhibit no symptoms. In fact, most cases are discovered with a Pap smear during a routine exam or during a test for another condition. Some women with VAIN experience some vaginal discharge, but this is usually caused by another associated infection, and not by the VAIN itself.
If your doctor suspects VAIN, they will likely make a diagnosis with the help of a colposcopy. A colposcopy is a procedure which allows your gynecologist to get a closer look at your vagina using a colposcope, which is a special magnifying lens.
In some cases, the gynecologist will also want to take a biopsy of your vaginal tissue. Removing the small sample can be uncomfortable, so a local or general anesthetic will usually be injected into the area.
Pap smear test
Also known as a liquid-based cytology test, this test uses a small brush to collect a sample of cells from your cervix. It’s usually not painful and shouldn’t require an anesthetic.
VAIN Treatment Options
In most cases of mild VAIN (VAIN 1), doctors will often monitor the condition closely and abstain from any proactive treatment unless it becomes necessary.
However, if a diagnosis of VAIN 2 or VAIN 3 is made, your doctor will likely recommend treatment in order to prevent vaginal cancer. Your particular course of treatment will vary depending on your medical history, the size, location, and severity of your condition, and whether or not you are pregnant or wish to become pregnant.
Ablation refers to the destruction of abnormal cells. Ablation can be accomplished through:
Carbon dioxide laser treatment
This is a procedure in which a tiny, high-energy laser beam is directed at the cells, destroying them. Usually, this is performed under general anesthetic, but if the affected vaginal surface area is small, it can also be performed under a local anesthetic.
Diathermy, also known as “deep heat,” is a treatment that involves directing a high-frequency electrical current to the area using an ultrasound, shortwave, or microwave instrument.
Following an ablation, it’s common to experience some light bleeding or vaginal discharge for 3-5 days. You should avoid intercourse, and refrain from putting anything into your vagina for 4-6 weeks, including tampons and douches.
This treatment isn’t typically recommended for most cases of VAIN, but it can be helpful for treating recurring VAIN or widespread VAIN. It involves inserting a small tampon-shaped device that contains a radioactive chemical into your vagina. You may need to keep the device in for several hours or a couple days.
Your doctor may recommend surgery if there is a possibility of any undetected cancer in the area, or if your case of VAIN is recurring. There are two primary surgical procedures for treating VAIN.
This is the surgical removal of the affected tissue as well as a border of normal tissue around the area to act as a “buffer zone.” Sometimes, the area can be stretched after the procedure to allow you to continue having vaginal intercourse.
Partial or total vaginectomy
This is the surgical removal of the vagina. Sometimes the surgeon can create a new vagina from the surrounding tissue.
After VAIN Treatment
You will need to schedule routine follow-up exams with your gynecologist to make sure the VAIN does not come back. You may need to receive additional treatment.
Effects on your sex life
Depending on your treatment, recovering from VAIN may have long-term effects on your sex life. You will want to avoid sex for several weeks following ablation, but typically you can return to your normal activities after completely healing. However, surgery and radiotherapy may have longer-lasting effects. Vaginectomy and vaginal reconstruction will likely have an effect on the sensations of sex. Neither surgery will have an effect on your clitoris, so you should retain the ability to orgasm.
Radiotherapy may cause soreness for the first few weeks, and in some cases can leave scars that harm your vagina’s elasticity. Your gynecologist can show you how to use a set of vaginal dilators if the scarring is affecting your sex life.