Vaginal cancer is a rare disease where abnormal cells grow out of control in the vagina, the muscular tube connecting the cervix to the outside of the body. While this cancer accounts for only a small fraction of all cancers affecting women, understanding its symptoms, causes, and risk factors can help with early detection and better outcomes.
Epidemiology
Vaginal cancer is an extremely uncommon form of cancer. It represents one of the rarest types of gynecologic cancers, making up only about 1 to 2 percent of all cancers that affect the female reproductive system.[2] To put this in perspective, approximately 1 in every 100,000 women will be diagnosed with this disease.[2] Together with vulvar cancer, these two conditions account for roughly 7 percent of all gynecologic cancers diagnosed in the United States.[7]
When we look at the overall cancer picture in the United States, estimates for 2025 suggest that there will be about 8,070 new cases of vaginal and other female genital cancers combined, with approximately 1,950 deaths.[16] This relatively small number highlights just how rare primary vaginal cancer is compared to more common cancers like breast or cervical cancer.
The disease follows a clear demographic pattern. Age plays a crucial role, as vaginal cancer most commonly affects older women. The average age at diagnosis for squamous cell carcinoma (the most common type, which begins in the flat cells lining the vagina) is around 60 years.[2] Most women with this cancer are between 50 and 70 years old.[4] However, it’s important to note that younger women can also develop vaginal cancer, particularly a rare form called clear cell adenocarcinoma, which is linked to exposure to a drug called diethylstilbestrol (DES) before birth.[2]
Squamous cell carcinoma dominates the landscape of vaginal cancers, making up approximately 80 to 90 percent of all cases.[16] Adenocarcinoma (cancer that begins in gland cells) accounts for only 5 to 10 percent of cases.[16] Other forms, including melanomas, sarcomas, and other rare types, are even less common.
Causes
Understanding what causes vaginal cancer can be challenging because the disease is so rare, and researchers continue to study its origins. However, several important factors have been identified that help explain why this cancer develops.
The most significant known cause is infection with human papillomavirus (HPV), particularly certain high-risk types. HPV is a sexually transmitted virus that can affect the cells lining the vagina.[2] Squamous cell carcinoma of the vagina is strongly associated with HPV infection, and studies have shown that this type of vaginal cancer shares many common risk factors with cervical cancer, which is also linked to HPV.[16] Even some cases of adenocarcinoma have been described in connection with HPV infection.[3]
Vaginal cancer nearly always results from an infection with certain types of HPV.[10] These particular strains of the virus can cause changes in the cells of the vaginal lining over time. Not everyone infected with HPV will develop cancer, but the persistent presence of high-risk HPV types increases the likelihood that normal cells will eventually become abnormal and then cancerous.
Another identified cause, though much rarer today, involves exposure to DES while developing in the womb. DES is a synthetic form of estrogen that was prescribed to pregnant women between 1940 and 1971 to help prevent miscarriages and other pregnancy complications.[2] Women whose mothers took this medication during pregnancy have an increased risk of developing a rare type of vaginal cancer called clear cell adenocarcinoma.[16] The incidence of this particular cancer peaked in the mid-1970s and is extremely rare now, reflecting the fact that DES is no longer used during pregnancy.[16]
Most vaginal cancers develop slowly. The process often begins with abnormal cells that are not yet cancerous, a condition called vaginal intraepithelial neoplasia (VAIN).[2] These precancerous cells exist in the vaginal lining but have not yet invaded deeper tissues. In some people, VAIN progresses to vaginal cancer, though researchers are still working to understand why this happens in some cases but not others.
Risk Factors
While anyone with a vagina can develop vaginal cancer, certain groups of people face a higher risk. Risk factors are characteristics, behaviors, or exposures that increase the chance of developing a disease. Having one or more risk factors does not mean someone will definitely get vaginal cancer, and some people without any known risk factors still develop the disease.
Age is the most important risk factor for most cancers, including vaginal cancer. The risk increases significantly as women get older, particularly after age 60.[2] This is why regular screenings and check-ups become even more important as women age.
HPV infection represents another major risk factor. Having multiple sexual partners increases the risk of HPV infection, as does being unvaccinated against HPV.[2] Since HPV is transmitted through sexual contact, behaviors that increase exposure to the virus also increase cancer risk. The good news is that HPV vaccines can protect against the most dangerous types of the virus, helping to prevent not only vaginal cancer but also cervical and other HPV-related cancers.
Women who have been diagnosed with VAIN face an elevated risk of developing vaginal cancer. VAIN itself is more likely to occur in people who have HPV.[2] The connection between VAIN and vaginal cancer underscores the importance of monitoring and treating precancerous changes before they progress.
A history of cervical cancer or cervical dysplasia (abnormal cells in the cervix) also increases risk.[2] Women who have been treated for cervical cancer may later develop vaginal cancer, possibly because the same risk factors (like HPV infection) affect both organs.
Smoking doubles the risk of developing vaginal cancer.[2] Tobacco use harms the body’s immune system and makes it harder to fight off HPV infections. The harmful chemicals in tobacco can also directly damage the DNA in cells, making cancerous changes more likely.
Women exposed to DES before birth carry a specific risk for clear cell adenocarcinoma. Although this medication is no longer prescribed during pregnancy, women born between the 1940s and early 1970s whose mothers took DES should be aware of this risk and discuss it with their healthcare providers.[2]
Finally, having had a hysterectomy (surgical removal of the uterus) for benign tumors or cancer has been identified as a risk factor.[16] The reasons for this association are not entirely clear, but it may relate to the underlying conditions that required the hysterectomy in the first place.
Symptoms
One of the challenges with vaginal cancer is that it often does not cause any symptoms in its early stages. Many women may not know they have it until their healthcare provider notices abnormal cells during a routine screening examination.[2] This is why regular pelvic exams and Pap tests are so important—they can detect vaginal cancer even when the body is not showing obvious signs of illness.
When symptoms do appear, they can vary depending on the size and location of the tumor. The most common symptom is abnormal vaginal bleeding. This might include bleeding that occurs after menopause, bleeding after sexual intercourse, or bleeding between menstrual periods.[1] Any bleeding that seems unusual or unexpected should be discussed with a doctor, as it could be a sign of vaginal cancer or another health problem.
Abnormal vaginal discharge is another symptom that women with vaginal cancer may experience.[1] This discharge might be different in color, smell, or consistency from what is normal for that individual. While vaginal discharge can have many causes, persistent or unusual discharge warrants medical attention.
Some women notice a lump or mass in the vagina.[1] This might be felt during self-examination or discovered by a healthcare provider during a pelvic exam. Any new lump should be evaluated promptly.
Pain during sexual intercourse can be another symptom of vaginal cancer.[1] While this symptom has many possible causes, if it is new or persistent, it should be discussed with a healthcare provider.
As the cancer grows or advances, additional symptoms may develop. Painful urination can occur if the tumor affects nearby structures.[1] Frequent urination, even when the bladder is not full, may also be a sign.[1] Constipation can develop if the cancer presses on the rectum or affects bowel function.[1] Pelvic pain, a more general discomfort in the lower abdomen or pelvic area, may also occur.[1]
In advanced stages, when the cancer has spread beyond the vagina to nearby parts of the body or lymph nodes, symptoms can include swelling in the legs and back pain.[5] These symptoms indicate that the disease may have progressed significantly and requires immediate medical evaluation.
Prevention
While there is no guaranteed way to prevent vaginal cancer, several steps can reduce the risk of developing this disease. Prevention strategies focus largely on reducing exposure to known risk factors, particularly HPV infection.
The HPV vaccine offers powerful protection against the types of HPV most likely to cause vaginal cancer. Because many vaginal cancers are associated with HPV types 16 and 18, getting vaccinated can significantly lower the risk.[4] The vaccine is most effective when given before someone becomes sexually active, but it can still provide benefits to people who have already been exposed to some HPV types. Public health guidelines recommend HPV vaccination for adolescents, and catch-up vaccination is available for older individuals who were not vaccinated earlier.
Regular cervical screening, including Pap tests and pelvic exams, plays a crucial role in prevention. While cervical screening primarily targets cervical cancer, these exams can also help detect abnormal cells in the vagina.[10] Finding and treating precancerous changes before they develop into cancer is one of the most effective prevention strategies. Women should follow their healthcare provider’s recommendations for how often to have these screenings, which typically depend on age and risk factors.
Avoiding tobacco is another important preventive measure. Since smoking doubles the risk of vaginal cancer, never starting to smoke or quitting if already a smoker can reduce risk.[2] Quitting smoking also benefits overall health in countless other ways, reducing the risk of heart disease, lung cancer, and many other conditions.
Practicing safer sex can help reduce the risk of HPV infection. Using condoms and limiting the number of sexual partners can lower exposure to HPV and other sexually transmitted infections. However, it’s important to understand that condoms do not provide complete protection against HPV because the virus can affect skin not covered by a condom.
For women who were exposed to DES before birth, being aware of the risk and having regular medical check-ups is important. Healthcare providers can monitor these women more closely for signs of vaginal cancer and other related conditions.[2]
Maintaining overall health through a balanced diet, regular physical activity, and avoiding excessive alcohol consumption may also contribute to lowering cancer risk in general, though specific evidence for vaginal cancer prevention is limited.
Pathophysiology
Understanding how vaginal cancer develops and affects the body involves looking at the changes that occur at the cellular and tissue level. The vagina is a muscular tube that connects the cervix (the lower part of the uterus) to the outside of the body.[2] It plays important roles in sexual activity, menstruation, and childbirth.
The inside of the vagina is lined with layers of cells. The type of cell where cancer begins determines the type of vaginal cancer. In squamous cell carcinoma, cancer starts in the squamous cells, which are thin, flat cells that form the vaginal lining.[2] This type spreads slowly and usually remains near the vagina at first, though it can eventually spread to the lungs, liver, or bones.[8]
In adenocarcinoma, cancer begins in the gland cells of the vagina. These cells produce and release fluids such as mucus.[8] Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes, making it potentially more aggressive.[8]
The process of cancer development typically begins with changes in normal cells. These changes, called mutations, cause cells to grow and divide in an uncontrolled way.[1] Instead of dying when they should, these abnormal cells continue to multiply. They can form a mass or tumor and eventually invade surrounding tissues.
When vaginal cancer spreads beyond its original location, it most commonly travels to nearby structures first. The cancer can grow into adjacent organs or tissues in the pelvis. It can also spread through the lymphatic system, reaching nearby lymph nodes. From there, cancer cells may travel to distant parts of the body through the bloodstream. The most common sites for distant spread (metastasis) are the lungs, and less frequently, the liver, bones, or other organs.[16]
The rate at which vaginal cancer grows and spreads varies depending on the type and other factors. Squamous cell carcinoma typically grows slowly, which is why early detection through screening can be so effective.[8] The cancer usually stays confined to the vagina for a considerable time before spreading.
The body’s immune system normally works to identify and destroy abnormal cells before they can become cancerous. However, when the immune system is weakened or overwhelmed, or when cancer cells develop ways to evade immune detection, the disease can progress. This is one reason why factors that weaken the immune system, such as smoking or chronic HPV infection, increase cancer risk.
As the tumor grows, it can cause symptoms by pressing on or blocking nearby structures. For example, a tumor that presses on the bladder can cause urinary symptoms, while one that affects the rectum can cause constipation.[1] When cancer invades blood vessels, it can cause abnormal bleeding, which is why vaginal bleeding is such a common symptom.
The stage of the cancer—how large it is and whether it has spread—determines much about how the disease will behave and how it should be treated. Cancer that is confined to the vagina has the best chance of being cured.[1] When it spreads beyond the vagina, treatment becomes more difficult, though still possible.