Introduction
Vaginal intraepithelial neoplasia (VAIN) refers to the growth of abnormal cells in the inner layer of the vagina. These abnormal cells do not grow in the deeper tissues or spread elsewhere. It is a rare disease that occurs less than one percent in all of the intraepithelial neoplasias (a condition where abnormal cells are found in the tissue lining of an organ) of the female genital tract. Even though vaginal intraepithelial neoplasia is not cancer, it might become cancerous when the changes become severe. Hence, medically this condition is called a precancerous condition. Vaginal intraepithelial neoplasia does not develop into cancer for most people.
What Are the Different Grades of Vaginal Intraepithelial Neoplasia?
Healthcare practitioners divide vaginal intraepithelial neoplasia into three groups.
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VAIN 1 is called a low-grade squamous intraepithelial lesion (LSIL). It occurs when abnormal cells occur in one-third of the vaginal lining thickness.
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VAIN 2 is when abnormal cells form in two-thirds of the thickness of the lining of the vagina.
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VAIN 3 refers to the formation of abnormal cells along the full thickness of the vaginal lining.
VAIN 2 and 3 are called high-grade squamous intraepithelial lesions (HSIL).
What Causes Vaginal Intraepithelial Neoplasia?
The common cause of vaginal intraepithelial neoplasia is human papillomavirus (a virus that causes abnormal tissue growths like warts), immunosuppression, and previous precancerous or cancer conditions. When an immune system is weak, it faces difficulty fighting infections like the human papillomavirus, which causes other precancerous conditions and conditions like vaginal intraepithelial neoplasia. Some conditions which affect the immune system include:
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Habits like smoking.
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Genetic diseases of the immune system.
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Medications taken after organ transplants.
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Blood disorders.
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Bone marrow disorders.
Women with precancerous changes or cancer in the cervix, vagina, vulva, or any other pelvic tissue or reproductive organ are at an increased risk of developing vaginal intraepithelial neoplasia. The chances are also high for women who have received radiation therapy for pelvic cancer treatment.
What Are the Symptoms Seen in Vaginal Intraepithelial Neoplasia?
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Usually, the symptoms seen in vaginal intraepithelial neoplasia vary. It can be asymptomatic in some people, whereas others may have certain symptoms, such as vaginal discharges and spots noted after sex.
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In addition, other infections can also cause these symptoms, so it is always important to consult the doctor if any of these symptoms are noted.
What Are the Risk Factors Of Vaginal Intraepithelial Neoplasia?
The risk factors of vaginal intraepithelial neoplasia are almost similar to cervical neoplasia. Some of the risk factors include:
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Beginning sexual activity very early in life.
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Having unprotected sex with multiple sexual partners.
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Consuming tobacco products.
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Having human papillomavirus infection.
Other risk factors include:
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History of vulvar or cervical cancer.
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Cervical intraepithelial neoplasia or vulvar intraepithelial neoplasia.
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Exposure to the drug diethylstilbestrol (DES).
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Immunosuppressive medications.
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A weak immune system resulting from the human immunodeficiency virus (HIV).
How Is Vaginal Intraepithelial Neoplasia Diagnosed?
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Vaginal intraepithelial neoplasia is diagnosed by a procedure called colposcopy.
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In this procedure, a colposcope (magnifying device) is used to test the surface of the vagina. This test is done to check for any abnormal areas.
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In some cases, a biopsy might also be done. A sample of tissue is removed from the abnormal areas and tested in a biopsy.
How Is Vaginal Intraepithelial Neoplasia Managed?
The treatment of vaginal intraepithelial neoplasia depends on the symptoms and its risks of developing into a cancerous lesion. VAIN 1 usually does not require any treatment. The abnormal cells usually disappear after some time. VAIN 2 and 3 are managed in several ways, like:
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A Close Follow-Up - In some people, the chances of the condition developing into cancer are very low. It is normally closely monitored, and treatment is recommended if changes are noted.
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Treatment With Creams - Imiquimod cream is an antiviral medication that destroys abnormal cells and boosts the immune system. This medication is mostly recommended for younger populations with VAIN in more than one area. The cream has to be applied to the affected area about three to four times a week. The medication will take about six months to work, and sometimes the vagina might get inflamed as a side effect of this treatment. The doctors will also recommend treatment with fluorouracil, a chemotherapy cream. However, this cream has to be applied more often and is not commonly used as it easily irritates the delicate vaginal skin.
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Laser Treatment - Laser treatment involves burning abnormal cells using a hot strong light beam. Before performing the procedure, the healthcare practitioner will use a local anesthetic solution to numb the area. Samples of tissues (biopsies) might also be taken before the laser procedure is performed. These samples are then sent to the laboratory for further examination.
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Surgery - Surgical intervention is recommended if the abnormal cells recur or a patient has had the uterus removed (hysterectomy). The surgeon will remove the normal cells and surrounding healthy tissues during surgery using wide local excision. The tissues will then be sent to the laboratory and examined under a microscope by the pathologist. Sometimes the surgeon may remove the abnormal cells using a small loop of wire containing an electric current. In this procedure, a healthy area of tissue will be removed to reduce the risk of the recurrence of the abnormal cells.
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Radiotherapy - This treatment modality is rarely used to treat vaginal intraepithelial neoplasia. It is used to treat when abnormal cells recur after treatment and whenever abnormal cells are present in several areas of the vagina. Internal radiotherapy or brachytherapy is usually used to treat VAIN. In this procedure, an applicator is first inserted into the vagina. A radioactive object called the source is put into the applicator to begin the treatment. The treatment is usually done for several hours over a few days.
Does Vaginal Intraepithelial Neoplasia Require Any Follow-Ups After Treatment?
Regular follow-up checkups are recommended after the treatment. The follow-up will be every few months in the beginning but will gradually decrease in frequency with time. The healthcare practitioner monitors the patient very closely to check for signs of recurrence. Follow-ups usually last several years since there is always a risk of recurrence of vaginal intraepithelial neoplasia even after treatment.
Conclusion
Vaginal intraepithelial neoplasia, also called vaginal dysplasia, is a condition that causes abnormal changes in the cells of the vaginal tissue. It can be caused due to various factors like human papillomavirus and immunosuppression. Most cases resolve independently, but sometimes, these changes can become cancerous when left untreated for several years. Management of vaginal intraepithelial neoplasia includes creams like Imiquimod and Fluorouracil, radiotherapy, and surgical intervention.
