Laser therapy for vaginal intraepithelial neoplasia after hysterectomy

In recent years there has been a marked increase in the number of reported cases of vaginal intraepithelial neoplasia (VAIN) after hysterectomy. Until about 10 years ago radiation or surgery had been the therapeutic modality mostly used for this disease. More recently, topical drugs, such as bleomycin and 5-fluorouracil cream, have been used, but they are often ineffective and poorly tolerated. For the last 14 years we have used the CO2 laser for the treatment of VAIN and have treated a total of 143 patients. Our use of a combination of wire sutures through the vaginal mucosa and the introduction of fluids into the underlying submucosal areas allows retraction and ballooning of the recesses and scars and permits us to place the vaginal mucosa at right angles to the laser beam to allow complete treatment.