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 and 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 many women who have VAIN will not develop cancer.
VAIN 1, 2 and 3
VAIN is graded 1, 2 or 3:
- VAIN 1 means the abnormal cells are in one third of the thickness of the vagina lining
- VAIN 2 means the abnormal cells are in two thirds of the thickness of the vagina lining
- VAIN 3 means the full thickness of the lining of the vagina has abnormal cells
Women who have VAIN 1 do not usually need any treatment. The cancerous cells often disappear after a while. Your doctor will arrange regular check ups to make sure this has happened.
Your doctor might recommend treating the abnormal cells if you have VAIN 2 or 3. This aim is to prevent vaginal cancer from developing.
Treatment for VAIN 2 and 3
There are a number of treatment options for VAIN 2 or 3.
A laser is a very 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 so that the cells can be examined.
You might have surgery, especially if the abnormal cells have come back or you have had a hysterectomy in the past.
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 are not standard treatment for VAIN and are usually used as part of clinical trials. Imiquimod cream (Aldara) is a newer cream being tested for VAIN. It is an antiviral drug that boosts the immune system to destroy the abnormal cells.
Some women might 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.
Radiotherapy is rarely used to treat VAIN. But 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.
You usually have internal radiotherapy (brachytherapy) to treat VAIN. 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.