Colposcope in a medical examination room

VIN and VaIN Excision

Overview

Vulval Intraepithelial Neoplasia (VIN) and Vaginal Intraepithelial Neoplasia (VaIN) are precancerous conditions involving abnormal changes in the skin or mucosa of the vulva or vagina. These changes are often caused by persistent human papillomavirus (HPV) infection. While they are not cancer, they have the potential to develop into cancer if left untreated.

Surgical excision may be recommended to remove areas of VIN or VaIN for diagnosis, symptom relief, or cancer prevention.

Understanding VIN and VaIN

  • VIN is categorised into usual-type (related to HPV, often in younger people) and differentiated-type (often not HPV-related and more likely to progress to cancer).
  • VaIN is rarer and typically associated with prior cervical abnormalities or HPV-related disease.
  • Both may be asymptomatic or cause itching, burning, or visible skin changes.

Why Excision Is Performed

Excision is generally recommended:

  • To confirm diagnosis and rule out invasive cancer
  • To remove high-grade VIN or VaIN (e.g., VIN 2 or 3 / VaIN 2 or 3)
  • If there is pain, itching, or visible lesions that affect quality of life
  • When medical treatments (e.g., imiquimod) are unsuitable or ineffective

How It’s Performed

VIN or VaIN excision is usually a day procedure, performed under general anaesthesia.

  • VIN Excision involves removing a segment of vulval skin with a margin of normal tissue.
  • VaIN Excision (if feasible) involves excising the affected vaginal epithelium (skin).
  • Biopsies may be taken at the time of excision to assess for multifocal disease.
  • The excised tissue is sent for histopathology.

In some cases, thermal ablation or topical treatment may be used instead or in addition.

Recovery and Aftercare

  • Expect tenderness, swelling, and discharge for 1–3 weeks.
  • Pain is usually manageable with simple pain relief.
  • Avoid intercourse, swimming, and baths for 4–6 weeks.
  • Sitz baths and topical treatments may be recommended to promote healing.

You’ll be reviewed in follow-up and further colposcopy or imaging may be arranged based on your histology results.

Risks and Considerations

  • Wound breakdown or delayed healing
  • Infection or bleeding
  • Scarring or distortion of vulval or vaginal anatomy
  • Recurrence of VIN or VaIN (monitoring is ongoing)

Future Monitoring

People with VIN or VaIN require long-term follow-up, as recurrence is common. This usually involves:

  • Regular colposcopy or vulvoscopy
  • Cervical screening (if applicable)
  • HPV testing
  • Self-examination or partner-assisted examination

Alternatives

  • Topical imiquimod (especially for HPV-related VIN)
  • Careful observation (for low-grade lesions or multifocal VaIN)
  • Excision followed by topical treatment in high-risk or recurrent cases
Dr Sam Holford

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FAQs

Is VIN or VaIN a type of cancer?
No, VIN and VaIN are pre-cancerous conditions, not cancer. This means there are abnormal cells that, if left untreated, have the potential to develop into vulval or vaginal cancer over time. Treatment is aimed at removing these cells to prevent this from happening.
What causes VIN and VaIN?
Most cases of VIN and VaIN are caused by persistent infection with high-risk types of the Human Papillomavirus (HPV), the same virus that causes most cervical cancers. A less common type of VIN is related to chronic skin conditions like lichen sclerosus.
What is the recovery like after surgical excision?
You can expect some tenderness, swelling, and discomfort for 1-3 weeks. The area needs to be kept clean and dry. You will be advised to avoid intercourse, swimming, and vigorous exercise for about 4-6 weeks to allow the delicate skin to heal properly.
Will the VIN or VaIN come back after treatment?
There is a risk of recurrence, as the underlying HPV infection or skin condition may still be present. This is why long-term follow-up with regular check-ups is very important. Quitting smoking can also significantly reduce the risk of recurrence.
Will surgery affect the appearance of my vulva or how sex feels?
The goal is always to remove the abnormal tissue while preserving normal anatomy and function as much as possible. While there will be a fine scar, every effort is made to ensure the cosmetic outcome is good and that sensation is not significantly affected. We can discuss this in detail.

Patient Resources

Why Choose Me?

I offer sensitive, respectful care for people with vulval and vaginal conditions—areas that can be associated with significant distress and stigma. As a colposcopist with experience in treating complex VIN and VaIN, I aim for clear communication, effective symptom relief, and minimising recurrence. I also collaborate with sexual health and dermatology specialists where needed for optimal multidisciplinary care.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.