— vaginal smear/biopsy/partial/subtotal vaginectomy/radical vaginectomy (with hysterectomy, salpingo-oophorectomy and lymphadenec-tomy)/pelvic exenteration.

— vaginal pathology may be asymptomatic or present with bleeding, discharge, dyspareunia, a feeling of discomfort or mass. Clinical examination and direct visualization by colposcopy can show dysplastic mucosal lesions (VAIN), warts, tumour and even changes related to diethylstilboestrol (DES) exposure (see below). Vaginal smear, punch or wedge biopsy allow a tissue diagnosis and the strong association with previous vulval, cervical and endometrial disease must be taken into account. Pelvic MRI is used to stage suspected tumour including the presence of any pelvic or inguinal lymphadenopathy, with the latter sometimes also amenable to investigation by FNA cytology. Surgery in the form of radical vaginectomy is used for localized, non-responsive or recurrent tumours, otherwise chemoradiation subject to assessment and discussion at a multidisciplinary meeting. Laser ablation and topical 5-fluorouracil are additional options for superficial mucosal wart or VAIN lesions. Pelvic exenteration is sometimes used for extensive local disease or post radiotherapy necrosis.

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