Vaginal Cancer Screening

Unlike cervical cancer, there is no routine screening test specifically recommended for vaginal cancer for people at average risk. Vaginal cancer is rare, and routine testing of people without symptoms has not been shown to provide enough benefit to recommend population-wide screening.

However, some people have a higher risk of developing vaginal precancer or cancer and may need continued surveillance. Your healthcare provider can recommend testing based on your history of cervical or vaginal precancer, human papillomavirus (HPV) infection, previous cancer, hysterectomy, or other risk factors.

How is vaginal cancer screening different from cervical cancer screening?

Cervical cancer has established screening recommendations that use HPV testing, Pap testing, or a combination of these tests to identify high-risk HPV infections and abnormal cervical cells before cancer develops.

There is no equivalent routine screening program for vaginal cancer.

One reason is that primary vaginal cancer is very rare. Screening large numbers of people who have no symptoms or increased risk has not been shown to provide enough benefit to recommend routine vaginal cancer screening.

Can a Pap test detect vaginal cancer?

A Pap test, also called a Pap smear, collects cells that are examined for abnormal changes. The test is primarily used for cervical cancer screening.

However, abnormal vaginal cells may sometimes be identified during a Pap test. This can be particularly relevant for people who have had their cervix removed or who are being monitored because of previous cervical or vaginal precancer.

An abnormal Pap result does not mean you have vaginal cancer. Additional evaluation is needed to determine whether the cells represent an HPV-related change, precancer, cancer, or another condition.

How does human papillomavirus affect vaginal cancer risk?

Persistent infection with high-risk human papillomavirus is one of the most important risk factors for vaginal cancer.

Most HPV infections go away on their own. When a high-risk HPV infection persists, however, it can cause abnormal changes in cells lining the vagina. Over time, some of these cells can become precancerous or develop into cancer cells.

HPV is particularly associated with squamous cell carcinoma, the most common type of vaginal cancer.

Can an HPV test screen for vaginal cancer?

An HPV test looks for high-risk types of HPV that can cause cancer. HPV testing is an important part of cervical cancer screening, but it is not recommended as a routine vaginal cancer screening test for average-risk people.

Depending on your medical history, your healthcare provider may use HPV testing as part of surveillance after certain cervical or vaginal abnormalities.

Having a positive HPV test does not mean you have vaginal cancer. Most people with HPV will never develop cancer.

What is vaginal intraepithelial neoplasia?

Vaginal intraepithelial neoplasia (VaIN) is a precancerous condition in which abnormal cells develop in the lining of the vagina.

VaIN is not invasive vaginal cancer. However, high-grade VaIN has a greater risk of progressing to cancer and may require treatment or close monitoring.

VaIN may be discovered after an abnormal Pap or HPV test or during an examination of the vagina. Identifying and appropriately treating high-grade vaginal precancer may help prevent some cases from developing into invasive vaginal cancer.

What risk factors may require additional surveillance?

Some people have risk factors that may change their recommended follow-up.

Additional surveillance may be appropriate for people with a history of:

• High-grade cervical precancer

• Cervical cancer

• Vaginal precancer or VaIN

• Vaginal cancer

• Persistent high-risk HPV infection

• Certain conditions that weaken the immune system

• Exposure before birth to diethylstilbestrol (DES)

Not everyone with these risk factors needs the same tests or follow-up schedule. Your healthcare provider can recommend surveillance based on your individual medical history.

Do you need vaginal cancer screening after a hysterectomy?

It depends on why you had the hysterectomy and your previous medical history.

A hysterectomy removes the uterus and may or may not include removal of the cervix. Removing the cervix does not remove the vagina, so vaginal precancer and vaginal cancer can still develop.

People who had a total hysterectomy for a noncancerous condition and have no history of significant cervical precancer or cervical cancer generally do not need continued routine cervical screening.

However, people with a history of cervical precancer, cervical cancer, VaIN, or certain other high-risk conditions may need continued surveillance after hysterectomy.

How are abnormal vaginal cells evaluated?

If a test or examination identifies abnormal cells, your healthcare provider may recommend further evaluation.

A colposcopy uses a magnifying instrument to closely examine the vagina and cervix for abnormal areas. If suspicious tissue is found, a biopsy may be performed.

During a biopsy, a small sample of tissue is removed and examined by a pathologist. A biopsy can determine whether abnormal cells are precancerous or cancerous and is necessary to confirm a vaginal cancer diagnosis.

Can a pelvic exam find vaginal cancer?

A pelvic exam is not considered a screening test that can reliably rule out vaginal cancer. However, a healthcare provider may sometimes notice an abnormal area, lump, lesion, or other change during an examination.

During a pelvic exam, the provider examines the vulva and vagina and may use a speculum to view the vaginal walls and cervix, if present.

Routine gynecologic care also provides an opportunity to discuss new symptoms, changes in your health, and any barriers that make it difficult to receive recommended follow-up care.

What is the difference between screening and vaginal cancer diagnosis?

Screening is testing someone who does not have symptoms. Diagnostic testing is performed when someone has a symptom or abnormal finding that needs to be investigated.

This distinction is especially important for vaginal cancer because there is no routine screening program for average-risk people.

If you develop abnormal vaginal bleeding, unusual discharge, pelvic pain, a vaginal lump, or another concerning symptom, you do not need to meet vaginal cancer screening criteria before being evaluated. Your healthcare provider can perform diagnostic testing to determine the cause.

What role does the HPV vaccine have in vaginal cancer prevention?

The HPV vaccine is an important form of vaginal cancer prevention, rather than screening.

Vaccination can prevent new infections with HPV types responsible for many vaginal, cervical, vulvar, anal, and other HPV-related cancers. It works best when given before exposure to HPV.

The vaccine does not treat an existing HPV infection, precancer, or vaginal cancer. It also does not replace recommended cervical cancer screening.

When should you talk to your doctor?

Talk with your doctor if you are unsure whether you need continued Pap testing, HPV testing, or another type of surveillance.

You should also make an appointment if you experience:

• Vaginal bleeding after menopause

• Bleeding after sex

• Unexplained bleeding between periods

• Persistent or unusual vaginal discharge

• A lump or mass in the vagina

• Pelvic pain or pressure

• Pain during sex

• Persistent urinary or bowel changes

These symptoms are more commonly caused by conditions other than cancer, but they should be evaluated.

What happens if screening or testing finds vaginal cancer?

If a biopsy confirms vaginal cancer, your healthcare team will perform additional testing to determine the cancer's stage and develop an appropriate treatment plan.

Cancer treatment depends on the type, size, location, and stage of the cancer as well as your overall health. Treatment is covered in detail in the Vaginal Cancer Treatment section of this guide.

Finding an abnormality does not always mean cancer treatment will be necessary. Precancerous changes and invasive vaginal cancer are different conditions and are managed differently.

What does the future of vaginal cancer screening look like?

Because vaginal cancer is rare, there is less research on screening than for more common cancers. Researchers continue to study HPV-related disease and ways to identify people who may have a higher risk of developing vaginal precancer or cancer.

In the future, research may help doctors better determine which higher-risk groups benefit from additional testing and how HPV-based testing can be used most effectively.

For now, the most important steps are to follow recommended cervical cancer screening guidelines, receive appropriate surveillance if you have increased risk, consider HPV vaccination when appropriate, and have concerning vaginal symptoms evaluated promptly.