Vaginal Intraepithelial Neoplasia (VaIN)-A Retrospective Cohort Analysis of Epidemiology, Risk Factors, and Management in an Academic Clinical Center

Abstract

Background: Vaginal intraepithelial neoplasia (VaIN) is a rare but potentially precancerous condition strongly associated with human papillomavirus (HPV) infection. Despite increased detection rates due to HPV screening and colposcopy, diagnosis and management remain challenging. This study aimed to evaluate the epidemiological characteristics, risk factors, and outcomes of VaIN in patients referred to a tertiary academic center. Methods: We conducted a retrospective analysis of 48 patients who underwent colposcopy-directed vaginal biopsies between January 2019 and June 2024 at the Medical University of Warsaw. Data collected included patient demographics, HPV status, cytology, histopathology, and treatment outcomes. Patients were grouped based on the presence and grade of VaIN (VaIN 1 vs. VaIN 2/3). Statistical analyses were performed using SPSS software. Results: VaIN was diagnosed in 24 patients (50%), VaIN was confirmed in half of the cohort, VaIN 2 in 30%, and VaIN 3 in 18% of cases. HPV infection and prior cervical pathology were significantly associated with VaIN diagnosis (P = 0.03 and P = 0.05, respectively), and high-risk HPV infection correlated with higher-grade lesions (P = 0.04). Among VaIN 2+ cases, most patients required laser ablation or surgical excision, while VaIN 1 often regressed spontaneously. Regression occurred in 11 cases, and high-risk HPV infection was inversely associated with spontaneous regression (P = 0.04). Conclusions: This study confirms the central role of HPV, particularly high-risk subtypes, in VaIN pathogenesis. Conservative management may be appropriate for VaIN 1, while VaIN 2+ requires active intervention. HPV genotyping should be integrated into diagnostic workups, and long-term follow-up is essential due to the risks of persistence and recurrence.

Keywords: cervical neoplasia; human papillomavirus; vaginal cancer; vaginal intraepithelial neoplasia.

Figure 1

Histopathological image of VaIN 1, showing mild nuclear atypia confined to the lower third of the vaginal squamous epithelium, without evidence of invasion. Hematoxylin and eosin stain (H&E), original magnification ×200.

Figure 2

Histopathological image of VaIN 2/3, demonstrating marked nuclear pleomorphism and loss of maturation involving more than two-thirds of the epithelial thickness. Hematoxylin and eosin stain (H&E), original magnification ×200.

Figure 3

Summary of key results of the study. Created with biorender.com.