Mild vaginal dysplasia — low-grade vaginal intraepithelial neoplasia (VaIN) — is a superficial epithelial abnormality of the vaginal mucosa. First-line treatment is directed at eliminating visible lesions and achieving durable remission, particularly in symptomatic or bulky presentations.
First-line management is centred on locally applied topical therapy. In cases where persistent high-risk viral infection is an additional factor, a combined approach incorporating a light-based technique may also be considered. The specific agent, application method, and any combination sequence are set out in the full structured protocol.
The primary clinical endpoint is clearance of vaginal lesions on completion of the treatment course, with sustained clearance confirmed at 6-month follow-up.
Treatment is considered for bulky warty disease depending on symptoms.
A very low dosing regimen of imiquimod 5% cream (0.25 g, once a week for 3 weeks) appeared to be an effective and well-tolerated treatment for low grade VaIN.
Topical ALA-PDT combined with CO2 laser appeared to be an effective, safe, and well-tolerated treatment for vaginal LSIL and hr-HPV infections.
Thirty-six of 42 (86%) patients from a study by Buck et al achieved clearance of vaginal lesions on completion of the initial course of treatment.
After the follow-up for at least 6 months, 92% of patients remained clear of VaIN.
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