Vaginal cancer is a rare type of cancer that starts in the tissues of the vagina, the muscular tube connecting the uterus to the outside of the body. It most commonly affects women over 60 and is often linked to persistent human papillomavirus (HPV) infection.

The vagina can be affected by cancer in two ways - primary vaginal cancer (beginning in the vagina), or a site of secondary tumour deposits (where cancer that begins in other parts of the body such as the uterus spreads to the vagina). 

There are different types of vaginal cancer, including:

• Squamous cell carcinoma – The most common type, developing in the vaginal lining.

• Adenocarcinoma – Less common, but more likely to spread.

• Melanoma and sarcoma – Rare forms that develop in deeper tissues.

Because vaginal cancer often develops without symptoms in the early stages, regular cervical screening tests and awareness of any unusual symptoms are key to early detection.

In its early stages, vaginal cancer may not cause noticeable symptoms. However, as the cancer progresses, symptoms may include:

• Unusual vaginal bleeding, especially after sex, between periods, or after menopause

• Pain during sex

• Persistent pelvic or vaginal pain

• Unusual vaginal discharge, which may be watery, bloody, or have a strong odour

• A lump or growth in the vagina

• Changes in urination, such as pain or difficulty passing urine

These symptoms can also be caused by other conditions, such as infections or menopause-related changes, but it’s important to see a doctor if they persist. Early diagnosis increases treatment options and improves outcomes.

Vaginal cancer is rare, but certain factors can increase the risk, including:

• HPV infection: Long-term infection with high-risk HPV strains is the biggest risk factor.

• Age: Most cases occur in women over 60.

• History of abnormal cervical cells or cervical cancer: Women who have had cervical dysplasia (abnormal cells) or cervical cancer have a higher risk.

• Smoking: Weakens the immune system, making it harder to fight HPV infections.

• Previous radiation therapy: Radiation treatment to the pelvis may slightly increase the risk of vaginal cancer.

• Exposure to diethylstilbestrol (DES): Women whose mothers took DES (a hormone used in pregnancy between the 1940s–1970s) have a higher risk of clear cell adenocarcinoma of the vagina.

HPV vaccination and regular cervical screening tests can help reduce the risk.

Because vaginal cancer is rare and symptoms can be vague, it is often diagnosed during a routine cervical screening test or pelvic exam. If your doctor suspects vaginal cancer, they may recommend:

• Colposcopy: A magnified examination of the vagina and cervix to check for abnormal areas.

• Biopsy: A small tissue sample is taken from the suspicious area to confirm if cancer is present.

• Imaging tests: MRI, CT, or PET scans may be used to assess if the cancer has spread.

If you experience unusual vaginal bleeding, pain, or any persistent symptoms, don’t wait for your next screening—see your doctor as soon as possible. Early detection improves treatment options and outcomes.

Treatment for vaginal cancer depends on the type, stage, and individual health factors. Common treatments include:

• Surgery: Small cancers may be removed with a local excision, but more advanced cases may require vaginectomy (removal of part or all of the vagina) or, in some cases, a hysterectomy.

• Radiation therapy: Often used as a primary treatment or after surgery to destroy remaining cancer cells.

• Chemotherapy: Used for advanced cases or when cancer has spread beyond the vagina.

• Targeted therapy and immunotherapy: Newer treatments that may be available through clinical trials for certain types of vaginal cancer.

Your healthcare team will tailor a treatment plan to your needs, and support services can help manage side effects and emotional wellbeing during treatment.