Vaginal polyp is a benign formation originating from the vaginal mucosa. It can occur both asymptomatically and with a variety of clinical manifestations: a feeling of pressure or a foreign body, bloody and other pathological secretions from the genital tract, postcoital bleeding. The diagnosis of vaginal polyps is based on the data of gynecological examination, colposcopy and morphological research methods. The treatment of the disease is exclusively operative ‒ a polypectomy is performed under local anesthesia.
ICD 10
N84.2 Vaginal Polyp
General information
Vaginal polyp was first described in 1966 by American oncologists G. Norris and G. Taylor, who conducted a clinical and pathomorphological study of 24 vaginal polyps. Vaginal polyps are rare in the general population. In most cases, they proceed benign, only about 1% of neoplasms undergo malignancy. Vaginal polyps are found in both newborn girls and women in the reproductive and postmenopausal period. The average age at the time of diagnosis is approximately 40 years.
Causes
The exact causes of vaginal polyps are not fully known. It is assumed that the main role in their development is played by changes in the level of sex hormones and mechanical damage to the walls of the vagina. Among the most significant risk factors for vaginal polyps are the following:
- Injuries. It is assumed that the occurrence of vaginal polyps occurs as a result of the reaction of granulation tissue and the delay in differentiation of fibroblasts at the site of injury.
- Pregnancy. The growth of vaginal polyps is associated with high levels of progesterone during gestation. After childbirth, the concentration of the hormone decreases, so there is a spontaneous regression of polyps.
- Menopause. Against the background of a deficiency of sex hormones due to a decrease in ovarian function, menopausal hormone therapy drugs containing estrogens and progestogens (for example, tibolone) can contribute to the growth of vaginal polyps.
- Taking antiestrogenic drugs. The growth of polypoid formations was noted during therapy with the antitumor drug tamoxifen due to its estrogenic effect on squamous epithelial cells of the vagina.
Pathogenesis
Despite the achievements of modern gynecology, the pathogenesis of vaginal polyps is still not completely clear. Nevertheless, there is indirect evidence that vaginal polyps represent reactive hyperplasia of the loose subepithelial zone of the vaginal wall in response to local damage against the background of an imbalance of sex hormones.
The influence of hormonal factors is confirmed by the presence of estrogen and progesterone receptors in the stromal cells of vaginal polyps detected during immunohistochemical examination. As for the detection of vaginal polyps in newborns, it is believed that maternal sex hormones cause their intrauterine growth.
Classification
Vaginal polyps can be single or multiple. By localization, vaginal polyps are distinguished, located on the side walls, in the lower, middle or upper third of the vagina. Histologically, vaginal polyps are divided according to the ratio of stromal and epithelial components into the following morphological variants:
- glandular – formed due to the proliferation of glandular tissue;
- fibrous – consist of connective tissue cells (myofibroblasts);
- glandular-fibrous – are growths of the glandular epithelium and the underlying connective tissue.
Symptoms
With small sizes, polypous formations most often proceed asymptomatically and are detected accidentally during a gynecological examination. With large or multiple vaginal polyps, a feeling of pressure or a feeling of a foreign body, as well as bleeding unrelated to menstruation, may bother. Also, the presence of a vaginal polyp may be signaled by spotting during or after sexual intercourse, dyspareunia.
Complications
Vaginal polyps rarely undergo malignancy. However, vaginal stump polyps require special attention after a hysterectomy performed for an oncogynecological disease (uterine body cancer, cervical cancer, ovarian cancer, etc.).
Vaginal polyps may be accompanied by infectious and inflammatory diseases of the lower genital tract. Timely detection and specific treatment of infections contribute to the prevention of long-term complications, including infertility, chronic pelvic pain, etc.
Diagnostics
Pathology diagnosis is carried out by an obstetrician-gynecologist. Vaginal polyps are usually detected during routine preventive examinations. The algorithm of examination of patients includes:
- Gynecological examination. When examined in mirrors on the mucous membrane of the vagina, single rounded or elongated formations are found on a leg or a wide base of whitish or pale pink color. Their size can vary from 0.5 cm to 4 cm. Multiple lesions are described only in pregnant women.
- Colposcopy. It helps to detect polyps of minimal size on the vaginal wall when examined through a colposcope at 10-15-fold magnification.
- Biopsy. Targeted sampling of vaginal polyp tissue for further histological examination is carried out under colposcopic control.
- Histological examination. It is performed to confirm the diagnosis and determine the morphological variant of the vaginal polyp. There may be single mitoses in the epithelium of the glands, scattered lymphocellular infiltration in the stroma.
- Cytological examination. When a full-fledged material is taken, cells of a single-layer or multi-layer flat epithelium are determined. Cytology is not informative in clinical practice, it is used only for scientific purposes.
Differential diagnosis is performed with cystic formations (Gartner’s cyst, paramesonephric ductal cyst, endometrial cyst, etc.), vaginal leiomyomas, malignant neoplasia, etc. Among the latter, it is necessary to exclude vaginal intraepithelial neoplasia, invasive vaginal carcinoma, botryoid sarcoma or rhabdomyosarcoma, etc.
Treatment
Treatment of a vaginal polyp outside pregnancy is exclusively operative ‒ polypectomy. According to the indications, antibacterial, antiviral and anti-inflammatory therapy is performed before the operation. To remove a vaginal polyp in gynecology, various methods of destruction are used, among which the following are most often used:
- CO2 laser vaporization. It is a low-traumatic and painless manipulation. The recovery period is short, scarring does not occur.
- Radio wave method. Highly effective, does not lead to the development of complications, can be used in women of any age.
- Diathermocoagulation. A rather traumatic method with the use of an electrocoagulator. Healing of the wound surface is completed in 1.5-2 months, there is a risk of scar formation.
- Cryodestruction. It is based on the effect of liquid nitrogen, which leads to the freezing of the tissue of the vaginal polyp and the complete destruction of its structure.
- Surgical method. It consists in excision of the vaginal polyp, performed in the operating room under general or local anesthesia, depending on the extent of the lesion. Tissue healing may take up to 2-4 months.
Prognosis and prevention
With timely diagnosis and treatment, vaginal polyps have a favorable prognosis. Degeneration into a malignant tumor occurs extremely rarely (less than 1% of cases). Relapse of the disease after a polypectomy, regardless of the chosen method of destruction, is not characteristic.
Prevention consists in preventing traumatization of the vaginal mucosa and rational treatment of infectious and inflammatory processes of the genitals. If hormonal disorders are detected in women of reproductive age, as well as in the period of perimenopause, their timely correction should be carried out. A preventive examination by an obstetrician-gynecologist must be carried out at least once a year with mandatory examination on a gynecological chair.