What are the other Names for this Condition? (Also known as/Synonyms)

• Adenosis of Vagina
• Adenomatous Vaginae
• VA (Vaginal Adenosis)

What is Adenosis of Vagina? (Definition/Background Information)

• Vaginal Adenosis (VA or Adenosis of Vagina) is the presence of benign cervical glandular tissue or benign endometrial glandular tissue in the vaginal wall that may occur due to various factors
• It can be described as part of a normal physiological process that is seen following menarche (the first occurrence of menstruation in a girl), in nearly half of the girls/women
• Vaginal Adenosis may develop due to factors that include hormonal exposure, topical medications or chemotherapy, and treatment of condyloma acuminatum (an infectious disease that is transmitted sexually)
• Adenosis of Vagina can also develop against a background of exposure to the chemical diethylstilbestrol (DES, a synthetic type of estrogen hormone). This is seen in a handful of cases affecting young women, whose mothers were previously exposed to DES during pregnancy
• No significant signs and symptoms or complications are noted. The condition may result in the presence of a mass on the vaginal wall. Vaginal Adenosis is associated with certain types of cancers including squamous cell and clear cell types
• A treatment may be undertaken for the underlying cause of Vaginal Adenosis, as required. The prognosis is mostly related to the underlying cause and its treatment

Who gets Adenosis of Vagina? (Age and Sex Distribution)

• Vaginal Adenosis is a common condition that is mostly seen in adult (healthy) women. It is estimated that around 40% of women may be present with this condition
• However, a wide age range of females including young girls (post-pubertal age) and older women may be observed with Adenosis of Vagina. VA in post-pubertal and older females is typically called Acquired Vaginal Adenosis
• Congenital Vaginal Adenosis: Some study reports indicate that the condition may be congenital in nature, and thus observed in newborn baby girls
• There is no known ethnic or racial preference

What are the Risk Factors for Adenosis of Vagina? (Predisposing Factors)

The following risk factors have been identified for Vaginal Adenosis:

• Application of topical chemotherapy on the vaginal wall (such as topical 5-fluorouracil therapy) increases the risk
• Laser therapy for condyloma acuminatum: This may cause, in some cases, excess damage to the surface squamous epithelium of vagina. This excessive damage to the epithelium occurs as a side effect. The subsequent repair of the damaged surface epithelium may result in the formation of Vaginal Adenosis
• Endogenous hormonal estrogen excess: In some women, increased hormones in the body during pregnancy (such as excess estrogen) can increase the risk for developing Vaginal Adenosis
• Trauma during birth
• According to some experts, the change of pH value in the vaginal environment can also result in VA
• Long-term use of oral contraceptives

Adenosis of Vagina has been observed in association with diethylstilbestrol (DES) exposure:

• Female children of women, who took this drug while pregnant, there may be numerous abnormalities detected in the vaginal tract more commonly than the rest of the population
• In DES-exposed women (before 21st week of pregnancy), DES causes abnormal fetal tissue development in the genital area. This result in an increased risk for formation of Vaginal Adenosis (VA). In non-exposed women, such genetic abnormalities are not noted
• The use of DES in pregnant women is mostly discontinued, and hence, the incidence of this factor resulting in VA is declining

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Adenosis of Vagina? (Etiology)

Adenosis of Vagina is the presence of benign cervical/endometrial glandular tissue in the vaginal tract. Normally, the lining of the vagina contains squamous epithelium. However, in Vaginal Adenosis, there is Müllerian-type glandular epithelium in the affected area.

This may be the result of several factors including:

• Treatment for cancer using topical medications or laser therapy for condyloma acuminatum
• Diethylstilbestrol-exposure: DES is a synthetically produced estrogen hormone. The incidence of Vaginal Adenosis in women, whose mother’s were exposed to DES is about 30%; while without DES-exposure, the condition is seen in about 8% of the women population
• Hormonal imbalance: Conditions causing excess estrogen in the body, such as pregnancy
• Birth trauma
• Any condition upsetting the pH balance of the vagina

In some cases, the cause of the condition is unknown or unidentified, and this is termed Idiopathic Vaginal Adenosis.

What are the Signs and Symptoms of Adenosis of Vagina?

Generally, there are no significant signs and symptoms directly associated with Vaginal Adenosis in a majority of cases.

• In some women, the condition can lead to the formation of a tumor mass; the lesions form on the mucosal surface
• The mass can be solid or cystic; if it occurs as a cystic mass, it is known as Cystic Vaginal Adenosis
• Rarely, the tumor can occur as a polyp
• It can cause abnormal vaginal discharge in some cases
• Occasionally, there may be burning sensation, painful sex, or pain after sex
• Some tumors may ulcerate and bleed

The signs and symptoms of the underlying condition causing Vaginal Adenosis may be observed.

How is Adenosis of Vagina Diagnosed?

A diagnosis of Adenosis of Vagina may involve the following steps:

• Complete physical examination including pelvic exam: In some cases, Vaginal Adenosis may be physically observed by the attending healthcare provider, due to pronounced signs and symptoms
• Evaluation  of medical (and family) history including history of DES exposure (in the mother), if any: Since, Vaginal Adenosis is 4-times more often seen in DES-exposed women, the presence of such abnormalities should prompt the healthcare provider to look for the same through a visual (pelvic) exam and a biopsy, if needed
• Colposcopy:
  • The cervix (including the vulva and vagina) is examined with an instrument, called a colposcope. This helps the physician get a magnified view of the cervix
  • In order for this procedure to be performed, the individual has to lie on a table, as for a pelvic exam. An instrument, called the speculum, is placed in the vagina to keep the opening apart, in order to help the physician visualize the cervix. The colposcope is then used to get a magnified view of the inside

Although the above modalities can be used to make an initial diagnosis, a vaginal tissue biopsy is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include: 

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred. This is due to the rarity of the condition, which can lead to a misdiagnosis
• Core biopsy of the tumor
• Open biopsy of the tumor

Vaginal tissue biopsy:

• A tissue biopsy is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

If there are other underlying conditions, then the following additional tests may be performed:

• Ultrasound scan of the abdomen
• CT or CAT scan with contrast of the abdomen and pelvis
• MRI scans of the abdomen and pelvis: Magnetic resonance imaging (MRI) uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones

A differential diagnosis may be undertaken to rule-out the following conditions:

• Endometriosis of vaginal wall
• Vaginal inclusion cyst
• Vaginal carcinomas

Note: If on a biopsy the presence of atypical tubo-endometrial Vaginal Adenosis is noted, then close follow-up is necessary. This is due to the fact that atypical tubo-endometrial Vaginal Adenosis is a precursor to clear cell carcinoma of vagina.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Adenosis of Vagina?

Significant complications from Vaginal Adenosis are generally not noted, because it is a benign condition.

• Vaginal Adenosis can lead to microglandular hyperplasia
• Occasionally, the condition is associated with squamous cell carcinoma of vagina
• In cases where DES-exposure is involved, there is a very high risk for the development of vaginal clear cell adenocarcinoma

How is Adenosis of Vagina Treated?

Vaginal Adenosis is caused by various conditions. The treatment depends upon the underlying cause of adenosis. However, a majority of women may not require any treatment.

• In many cases, the treatment involves hormonal manipulation; restoring any hormonal imbalance in the body
• Chemical treatment using silver nitrate solution may be recommended
• Since one of the reasons of the condition is a change in the pH value in the vaginal environment, maintaining an acidic environment may be helpful. This can be achieved by using powders or washes that increase the acidity of vagina. These include:
  • Boric acid powder bath
  • Vaginal wash using 0.5% acetic acid
• No specific treatment may be necessary for some cases of Vaginal Adenosis, unless certain abnormalities are noted
• Follow-up care with regular screening and check-ups are important

How can Adenosis of Vagina be Prevented?

Current medical research has not established a method of preventing Adenosis of Vagina.

• The incidence of Vaginal Adenosis caused by DES-exposure is on the decline worldwide
• Addressing or treating any medical issue that alters the vaginal environment pH balance
• Medical screening at regular intervals with scans and physical examinations are advised

What is the Prognosis of Adenosis of Vagina? (Outcomes/Resolutions)

• The prognosis of Vaginal Adenosis is generally excellent, since it is a benign and normal physiological condition of no clinical significance, in a majority of cases
• However, if it is associated with an underlying cause, then the prognosis is linked to early detection and adequate treatment of the underlying condition

Additional and Relevant Useful Information for Adenosis of Vagina:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/