Vulvar and vaginal intraepithelial neoplasia (VIN/VAIN) 3

VIN 3 and VAIN 3 are associated with HPV infection of the lower genital tract. Compared to CIN they are much less frequent, but there has been an increase in the incidence of VIN over the last decades. VIN often causes pain and pruritus, while VAIN is asymptomatic in most cases and is diagnosed after abnormal Pap smear. VIN and VAIN are treated similarly. Single lesions can be excised. (Hemi-) vulvectomy or partial vaginectomy is necessary in cases of large or multifocal lesions. Laser vaporization is another effective treatment method. The immune modulator imiquimod is the most popular medical treatment. Recurrence of VIN and VAIN after treatment is not uncommon. Progression to invasive cancer happens in 5-10%. New methods like photodynamic therapy can help to improve the treatment of VIN and VAIN in the future. © Springer-Verlag 2012.