Chapter 9 Diseases of the Vagina
Benign vaginal disease
Vaginal diseases can manifest as benign, premalignant or malignant conditions
Benign
Vaginal cysts are not uncommon but are rarely large. They are found in the anterior or lateral walls of the lower third of the vagina and in the posterior wall of the upper third, are seldom larger than a walnut, are sometimes multiple, and may be mistaken for a cystocele. These cysts are occasionally a cause of dyspareunia but they usually cause no symptoms at all.
Traumatic epithelial cysts
Traumatic epithelial cysts (inclusion cysts) are found usually in the lower vagina and are caused by an infolding of epithelium at repair operations. If they cause any symptoms, they should be excised or marsupialised.
Malignant and premalignant disease
Vaginal intraepithelial neoplasia (VAIN)
This can be a very difficult condition to treat. It is rare, can affect any point on the vaginal wall and may progress to an invasive malignant disease. Its aetiology is likely to be due to human papilloma virus infection. The mature epithelium and a lack of metaplastic change may explain its reduced incidence when compared to cervical intraepithelial neoplasia.
It is often asymptomatic but symptoms may include irregular vaginal bleeding or discharge. Diagnosis is usually by colposcopy with directed biopsy, but it may also be detected incidentally in histology after a hysterectomy.
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