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Vaginal Cancer

Vaginal cancer starts in the lining of the vagina. It is one of the rarest gynaecological cancers and is most common in people aged 75 and over. Around 6 in 10 cases are attributed to HPV.

~63%of vaginal cancers in the UK are attributable to HPV

Attributable to HPV. Source: (Parkin, 2011). Some estimates are higher, and the NHS describes vaginal cancer as almost always HPV-related

What it is

The vagina is the muscular tube that connects the cervix and womb to the outside of the body. Primary vaginal cancer starts in the vagina itself. It is less common than cancer that has spread to the vagina from somewhere else, such as the cervix or womb.

Most vaginal cancers are squamous cell carcinomas, which start in the thin cells lining the vagina. Rarer types include adenocarcinoma and melanoma. Anyone with a vagina can get vaginal cancer, but it is rare under the age of 40.

Symptoms

  • A lump in the vagina
  • Ulcers or other skin changes in or around the vagina
  • Bleeding from the vagina after the menopause
  • Bleeding after sex, or pain during sex
  • Bleeding between periods
  • Smelly or bloodstained vaginal discharge
  • An itch in the vagina that won’t go away
  • Pain when peeing, or needing to pee a lot
  • Pain in the pelvis or vagina that doesn’t go away

Early vaginal cancer may cause no symptoms.

These symptoms are often caused by something less serious, but get them checked by your GP as soon as possible.

Causes

Most vaginal cancers are caused by long-lasting infection with high-risk types of HPV, and the NHS describes it as almost always HPV-related. As with cervical cancer, the infection has to last for many years before it causes cancer.

Statistics

300people diagnosed in the UK each year
120deaths from vaginal cancer in the UK each year
75%of cases are considered preventable
8 in 10women aged 15 to 49 survive 5 years or more

Survival is lower in older age groups. Sources: Cancer Research UK; NHS.

Risk factors

  • HPV infection, the main cause
  • Age. It is most common in people aged 75 and over
  • Having had cervical cancer or pre-cancerous changes of the cervix (CIN)
  • Vaginal intraepithelial neoplasia (VaIN), a pre-cancerous condition
  • Smoking
  • A weakened immune system, for example from HIV
  • Previous radiotherapy to the pelvis
  • Exposure to diethylstilboestrol (DES) in the womb. This hormone was given to some pregnant women between the 1940s and 1970s and is linked to a rare type of vaginal cancer

How it develops

HPV infects the cells lining the vagina and, through its E6 and E7 proteins, causes abnormal changes called vaginal intraepithelial neoplasia (VaIN). VaIN is graded from 1 (mild) to 3 (severe). It is not cancer, and it is often found during a colposcopy for cervical changes.

High-grade VaIN is usually treated because, over many years, it can develop into invasive cancer. Because the vagina and cervix are affected by the same HPV types, people who have had CIN or cervical cancer have a higher chance of developing VaIN.

Diagnosis and treatment

Your GP may examine you and refer you to a gynaecologist for a closer look (colposcopy) and a biopsy. Treatment is most often radiotherapy, sometimes with chemotherapy, and surgery is used for some early cancers.

Prevention

  • Go for cervical screening and follow up any abnormal results, as cervical and vaginal cell changes are caused by the same HPV types.
  • Get the HPV vaccine if eligible, and stop smoking.
  • Report unusual bleeding, especially after the menopause.

Trans women and non-binary people

HPV in the vagina of trans women who have had genital surgery hasn’t been well studied. If you notice any symptoms, see your GP or gender clinic.

Support and charities

NHS guidance

NHS and trusted information