Last reviewed October 2014
The vagina is a muscular tube that is sometimes called the birth canal. It is about 7.5 – 10 cm long and extends from the opening of the uterus, the cervix, to the external part of a woman’s genitals, the vulva. The vagina is the passageway through which menstrual blood flows, sexual intercourse occurs and a baby is born.
There are two main types of cancer that start in the vagina. They make up about 85% of all cancers of the vagina:
- Squamous cell carcinoma– the most common type of cancer, affecting cells covering the surface of the vagina. It usually grows slowly over many years and commonly affects women aged 50–70.
- Adenocarcinoma – a type of cancer that begins in the glandular cells lining the vagina. This type is more likely to spread to other organs and usually affects women less than 25 years old but can occur in other age groups.
It is more common to have secondary cancers in the vagina. This means the cancer has spread from another part of the body. The cancer may spread from the cervix, uterus (womb), vulva, or nearby organs such as the bladder or bowel.
Often there are very few symptoms with vaginal cancer but you may be aware of one or more of the following:
- bloody vaginal discharge not related to your menstrual period that may have an offensive or unusual smell
- pain during sexual intercourse
- bleeding after sexual intercourse
- pain in the pelvic area
- a lump in the vagina.
Some women also have bladder and bowel problems. You may have blood in your urine or feel the urge to pass urine frequently or during the night. Pain in the rectum can sometimes occur.
If you have any of the above symptoms it’s important to have them checked by your doctor, but remember they are common with many other conditions and most people with these symptoms will not have cancer.
The exact cause of vaginal cancer is unknown. Some factors that increase the risk include:
Vaginal intraepithelial neoplasia (VAIN)
This is a precancerous condition of the vagina sometimes caused by human papillomavirus (HPV). VAIN doesn’t often cause symptoms and many women are diagnosed while having tests for other reasons. It means that the cells in the inner lining of the vagina are abnormal and they may develop into cancer after many years. Not all women with VAIN develop cancer.
This condition causes abnormal cells to form in the tissue of the vagina. This is usually the result of DES exposure (see section below).
Human papillomavirus (HPV)
Sometimes known as the wart virus, HPV is a common sexually transmitted infection. There are many types of HPV and only some increase the risk of developing vaginal cancer. Most women with HPV do not develop cancer of the vagina.
Cigarette smoking doubles the risk of developing vaginal cancer. This maybe because smoking can make the immune system work less effectively.
Radiotherapy to the pelvis
If you have had radiotherapy to the pelvis for another reason, you are at a slightly higher risk of vaginal cancer. This complication is very rare.
History of gynaecological cancer
Cancer of the vagina is more likely to be diagnosed in women who have had cervical cancer or early cervical cell changes that were considered to be pre-cancerous.
A synthetic hormone drug that has been identified as a cause of vaginal cancer. Between 1938 and 1971 – and occasionally beyond – DES was prescribed to pregnant women to prevent miscarriages. It is no longer prescribed to pregnant women in Australia.
Daughters of women who took DES (called DES daughters) have an increased risk of developing a range of health problems including vaginal adenocarcinoma.
About one in 1,000 DES daughters develop adenocarcinoma particularly a type called clear cell carcinoma. This incidence of DES-related adenocarcinoma is highest for women were exposed during the first three months of their mother’s pregnancy.
The risk appears to be highest for those in their teenage years and early 20s. However, older women have also been diagnosed, so DES daughters should talk to their GPs about having regular medical examinations throughout their lives.
Vaginal cancer is not infectious and it can’t be passed to other people through sexual contact. It is not caused by an inherited faulty gene and can’t be passed on to children.
Information reviewed by: Prof Jonathan Carter, Head Gynaecologic Oncology, Chris O’Brien Lifehouse, Professor of Gynaecological Oncology, University of Sydney, and Head Gynaecologic Oncology, Royal Prince Alfred Hospital, NSW; Ellen Barlow, Gynaecological Oncology Clinical Nurse Consultant, Gynaecological Cancer Centre, The Royal Hospital for Women, NSW; Jason Bonifacio, Practice Manager/ Chief Radiation Therapist, St Vincent’s Clinic, Radiation Oncology Associates and Genesis Cancer Care, NSW; Wendy Cram, Consumer; Kim Hobbs, Social Worker, Gynaecology Oncology, Westmead Hospital, and Chair COSA Social Work Group, NSW; Lyndal Moore, Consumer; Pauline Tanner, Cancer Nurse Coordinator, Gynaecological Cancer, WA Cancer and Palliative Care Network, WA.