ABSTRACT
The procedure of simple vaginectomy, or colpectomy, whether partial or complete, is infrequently performed as an isolated procedure but can be of value in selected situations. The most common contemporary indication is vaginal intra-epithelial neoplasia (VAIN, melanoma in situ), which is most often identified in the upper vagina. The lesion may appear concomitantly with cervical intraepithelial neoplasia (CIN), a de novo lesion (in the presence or absence of a uterus), or appear as persistent or recurrent disease following noninvasive or ablative strategies, such as 5-florouracil cream or laser ablation. If hysterectomy is indicated for CIN, ideally this should be performed vaginally in conjunction with colposcopy to reduce the likelihood of the CIN and any associated VAIN being incompletely excised. In a small minority of patients (<2%), the transformation zone may naturally extend onto the vaginal vault. If such patients have had a hysterectomy for CIN without accurate colposcopy, then there is a risk of leaving part of the lesion behind. Due to the prevalent habit of closure of the vaginal vault, the lesion may be included in the suture line, resulting in the risk of an occult focus of CIN developing into a cancerous lesion with time.
