How is vaginal cancer diagnosed?

Your doctor will ask to do a physical examination of your vagina, groin and pelvic area. You will remove your clothing from the waist down, then lie on a table with your knees bent and legs apart. The doctor may arrange for you to have the examination under a general anaesthetic if the area is very painful. If you feel embarrassed or scared about this examination, let your doctor know. A nurse may be present, but you can also ask for a family member or friend to be in the room.

During the physical examination, you may have a cervical screening test to check the cells inside the vagina and cervix.

The cervical screening test looks for cancer-causing types of HPV in a sample of cells taken from the cervix or vagina. While the speculum is in place for the physical examination, the doctor will use a small brush or swab to remove some cells from the surface of the cervix. This can feel slightly uncomfortable, but it usually takes only a minute or two.

The sample is sent to a laboratory to check for HPV. If HPV is found, the pathologist will do an additional test on the sample to check for cell changes.

The results may show early cell changes in the lining of the vagina. This condition is called vaginal intraepithelial neoplasia or VAIN.

The doctor uses a magnifying instrument called a colposcope to look at the vulva, vagina and cervix in detail. The colposcope is placed near your vulva but does not enter your body. A colposcopy that examines the vagina is sometimes called a vaginoscopy.

You will lie on your back on an examination table or semi-upright on a colposcopy chair, with your knees up and apart. The doctor will use a speculum to spread the walls of the vagina apart, and then apply a vinegar-like liquid or iodine to your vulva and vagina. This makes it easier to see abnormal cells through the colposcope. The liquid may sting or burn, and you may have a brown discharge afterwards. During a colposcopy, the doctor will usually take a biopsy from the vagina.

You will be advised not to have sex or put anything in your vagina (e.g. tampons, medicine) for 24 hours before a colposcopy. Talk to your doctor about whether you should take over-the-counter pain medicines about an hour before the procedure to ease discomfort.

During the colposcopy, your doctor will usually take a small tissue sample (biopsy) from the vagina. A biopsy is the best way to diagnose vaginal cancer.

The doctor will usually put a local anaesthetic into the affected area of your vagina to numb it before the biopsy. There should not be any pain when the sample is taken, but you may feel a little discomfort.

If several areas of the vagina look suspicious, you may have several biopsies taken under general anaesthetic.

After the biopsy your vagina may bleed a little. Sometimes stitches are needed to close up the wound. Your doctor will explain how much bleeding to expect afterwards and how to care for the wound. You may have some soreness, which can be relieved by taking painkillers. You will be advised not to have sex or put anything in your vagina (e.g. tampons, medicine) for 24 hours after the biopsy.

The tissue sample will be sent to a laboratory, and a specialist doctor called a pathologist will look at the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of vaginal cancer it is.

If the tests show that you have vaginal cancer, further tests may be needed to find out whether the cancer cells have spread. 

You will probably not need to have all of these tests but they may include:

Blood test – These check your general health, and how well your kidneys and liver are working.

Chest x-ray – This painless scan that produces an image of your lungs.

CT scan – A CT (computerised tomography) scan uses x-ray beams to create detailed pictures of the inside of your body. Before the scan, you may be given a drink or injection of a dye called contrast that makes the pictures clearer. The CT scanner is large and round like a doughnut. You will lie on a flat table that moves in and out of the scanner. The scan is painless and takes 5–10 minutes.

MRI scan – An MRI (magnetic resonance imaging) scan uses a magnet and radio waves to create detailed pictures of the inside of your body.  Sometimes dye is injected before the scan to make the pictures clearer. You will lie on a treatment table that slides into a metal cylinder that is open at both ends. The machine can be quite noisy, but you will usually be given earplugs or headphones. If you think you may become distressed or are claustrophobic, talk to the medical team beforehand – they may offer you medicine to help you relax.

PET–CT scan – A PET (positron emission tomography) scan combined with a CT provides more detailed information about the cancer. Only some people need this test, and it is currently not funded by Medicare for vaginal cancer.

Cystoscopy – The doctor uses a slender, flexible tube with a camera and light (cystoscope) to look inside the urethra and bladder. This can be done under local or general anaesthetic.

Proctoscopy – The doctor uses a slender tube with a camera and light (proctoscope) to look inside the rectum and anus. This can be done under local or general anaesthetic.