Fast Five Quiz: Vaginal Health

Michel E. Rivlin, MD

Disclosures

October 01, 2021

Vaginal cancer is uncommon, especially primary vaginal cancer, as most lesions are metastatic from another primary site. Metastases typically come from reproductive organs (eg, cervix, endometrium, ovary); however, they can also come from other sites (eg, colon, breast, pancreas). The duration of symptoms in vaginal cancer averages 6-12 months before diagnosis, with a range of 0-11 years. Delay in the diagnosis of vaginal carcinoma is not uncommon; this is partially due to the rarity of the disease, as well as with delays in relating patient symptoms to a vaginal origin. As expected, the longer the delay, the more advanced the cancer once the diagnosis is made, resulting in a poorer outcome.

Painless vaginal bleeding is the most common symptom, accounting for the vast majority of presentations. Bleeding is postmenopausal in most patients, which is consistent with the peak age of 60 years for squamous cell carcinoma, the most common type of vaginal cancer. Menorrhagia, intermenstrual bleeding, and postcoital bleeding have also been reported.

Vaginal discharge occurs in about one third of patients. Some patients report urinary symptoms, which are caused by an anterior lesion compressing or invading the bladder, the urethra, or both. This causes bladder pain, dysuria, urgency, and hematuria. Patients may also have pelvic pain. Posterior lesions compress or invade the rectosigmoid, which causes tenesmus or constipation.

Few patients report a vaginal mass or vaginal prolapse. As many as one quarter of patients are asymptomatic; diagnosis is made during routine pelvic examination. The cancer tends to be caught at a much earlier stage in these patients than in those who have symptoms, and their prognosis is much better.

Read more about vaginal cancer.

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