The Management of Vaginal Intraepithelial Neoplasia after Hysterectomy

Twenty-three patients with vaginal intraepithelial neoplasia (VaIN) presented between 6 months and 13 years after hysterectomy for cervical intraepithelial neoplasia. All were discovered by cytological follow-up, were colposcopically assessed and diagnosis confirmed by histological examination before treatment. The CO2 laser was used as the initial treatment in 14, but only six remain free of disease after mean follow-up of 30 months. The reasons for the disappointing results with this form of therapy are discussed and it is suggested that its use may be inappropriate in the management of VaIN following hysterectomy as atypical epithelium may frequently be inaccessible as a result of being sequestered above the vault suture line or hidden in the recesses of the angles of the vaginal vault.