Vaginal intraepithelial neoplasia (VAIN)

Vaginal intraepithelial neoplasia (VAIN) means that there are abnormal cells in the inner lining of the vagina.

VAIN is not cancer. The abnormal cells or changes are only in the lining of the vagina. They haven’t begun to grow into the deeper tissues of the vagina or spread anywhere else.

When these changes are severe they could turn into cancer, so doctors may call this a pre cancer. But most people who have VAIN will not develop cancer.

Grades of VAIN

Doctors divide VAIN into 3 groups:

VAIN 1 means the abnormal cells are in one third of the thickness of the vaginal lining
VAIN 2 means the abnormal cells are in two thirds of the thickness of the vaginal lining
VAIN 3 means the abnormal cells are in more than two thirds of the thickness of the vaginal lining

Your doctor may also call VAIN 1 low grade squamous intraepithelial lesion (LSIL). And VAIN 2 and 3 high grade squamous intraepithelial lesion (HSIL).

Human papilloma virus (HPV) is the most common cause of VAIN.

Diagram showing the layers of the vaginal wall

Symptoms of VAIN

The symptoms of VAIN can vary. Most people will not have any, but some people may have:

spotting after sex
vaginal discharge

These can be caused by other conditions, such as infection. You should see your doctor if you have any symptoms.

Your doctor or nurse may pick up signs of VAIN during routine cervical screening.

Tests to diagnose VAIN

You usually have a colposcopy. This is a test to look at the surface of your vagina with a magnifying device (a colposcope). This can show up any abnormal areas.

You might also have a small sample of tissue (biopsy) taken from any abnormal areas.

Treatment options

Your treatment depends on where the VAIN is, your symptoms, and the risk of it developing into cancer. Your doctor may offer you:

no treatment, and follow you up closely
laser treatment
surgery
treatment with creams
radiotherapy

VAIN 1 does not usually need any treatment. The abnormal cells often disappear after a while. Your doctor will arrange for you to have regular check ups.

There are a number of treatment options for VAIN 2 or 3. You might have more than one of them.

Close follow up

For some people the risk of developing cancer is very low. Your doctor will monitor you closely and suggest you have treatment if there are any changes.

Laser treatment

A laser is a strong, hot beam of light that burns away the abnormal cells. Your doctor will use local anaesthetic to numb the area.

You might have some samples of tissue (biopsies) taken before the laser treatment. Your doctor sends the samples to the laboratory to be examined.

Surgery

Your surgeon removes the abnormal cells and some surrounding healthy tissue. This is called a wide local excision. They send the tissue to the laboratory and the pathologist looks at the cells under a microscope.

Sometimes, a surgeon might remove the area of abnormal cells with a small loop of wire that has an electric current. This is called loop diathermy or LEEP. They remove a surrounding area of healthy tissue to lower the risk of the abnormal cells coming back.

Creams

Imiquimod cream

This is an antiviral drug that boosts the immune system to destroy the abnormal cells.

Doctors tend to recommend this to younger people that have more than one area of VAIN.

You usually apply the cream to the affected areas 3 to 4 times per week, and it can take up to 6 months to work. Inflammation of the vagina is a common side effect of this treatment.

Fluorouracil

Your doctor might recommend you have treatment with a chemotherapy cream called fluorouracil. This needs to be applied often and can irritate the delicate skin of the vagina. So it is not commonly used.

Internal radiotherapy

Very rarely, internal radiotherapy (brachytherapy) is used to treat VAIN. You might have it if the pre cancerous cells have come back after treatment or you have abnormal cells in several areas of your vagina.

An applicator is put into the vagina. A radioactive object called a source goes into the applicator to give the treatment. You may have this treatment over several hours or a few days.

Follow up

You have regular check ups in the hospital clinic. At first, your follow up appointments are every few months. But if all is well, they gradually become less frequent. They monitor you closely to check there are no signs that the VAIN has come back.

Follow up is usually for many years. This is because there is a risk that VAIN may return after treatment.