[The Pap test in women after hysterectomy]

Neoplasm of the vaginal vault may occur up to years after a hysterectomy for CIN in 0.9-6.8% It is less commonly observed following hysterectomy for benign disease. The explanations for the pathogenesis of dysplastic abnormalities in the vaginal epithelium after hysterectomy are: residual disease indicating inadequate excision of the original lesion; multicentre focus of origin; new or recurrent lesion due to persistent carcinogenic stimulus. The subsequent development of VAIN justified the intensive cytology follow-up after hysterectomy? The general population are not screened for vaginal carcinoma, but they are screened for cervical carcinoma. The risk of vaginal carcinoma after hysterectomy for pre-invasive carcinoma of the cervix is similar to the incidence of pre-invasive carcinoma of the cervix in the general population. In the absence of any definite evidence that the natural history of the two diseases is different, most authorities recommend that vault cytology must be continued for life, although some people think that screening for vaginal carcinoma in women who have had CIN completely excised at hysterectomy is not an efficient use of resources. There is a need for continuing cytological follow-up, even after hysterectomy for benign conditions.