What’s vaginal intraepithelial neoplasia?

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Vaginal intraepithelial neoplasia (VAIN) is a cellular change in the surface tissue of the vagina. This condition is not malignant, but could develop into cancer; a patient can receive treatment to prevent this potential complication if it seems necessary. Patients with a history of cellular changes around the vagina and cervix may be candidates for aggressive treatment because they may have a higher risk of cancer. In other cases, the changes may be monitored, but not treated, to determine if they resolve on their own.

Patients usually receive a diagnosis of vaginal intraepithelial neoplasia after an examination for an unrelated problem, such as a routine peroxidase-antiperoxidase (PAP) smear to check the cervix. The growth can be described as precancerous to reflect the fact that it can become malignant, but that doesn’t mean the cells are dangerous. They can appear in different regions of the vagina and sometimes spread to the nearby vulva and other areas. The classification is based on the level of infiltration; if the entire epithelium is involved it is grade three, while a thinner vaginal intraepithelial neoplasia may be grade one or two.

A care provider can meet with the patient to discuss options. Increased routine testing and improved pathology techniques have increased the number of diagnoses of cellular changes and sometimes result in situations where patients pursue aggressive treatment for something that was not dangerous. Your doctor may consider whether you have a history of human papilloma virus or other potential risk factors for cancer when deciding whether to recommend treatment. If the patient’s history is generally sound, a wait-and-see approach may be best.

For cases of vaginal intraepithelial neoplasia that require treatment, there are several options. A topical chemotherapy cream can be used to attack the cells, and radiation therapy can be considered for patients with deeper tumors. Surface ablation and cell resection surgery are also available for patients with vaginal intraepithelial neoplasia which has the potential to continue to grow and eventually become cancerous. Patients can discuss the risks and benefits of all options to determine which would be best for their needs.

Receiving a pathology report that cellular changes are occurring can be scary, because patients may assume it means they have cancer. It’s important to be aware that abnormal cell growth can occur without being malignant, and that precancerous growths sometimes resolve on their own without treatment or never turn into cancer. Patients need an individual assessment to determine the level of concern based on the specifics of the situation and their history.

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