Due to thinning of the vaginal epithelium and vulnerable stroma in the postmenopausal period, traumatic erosions (small tears) appear, usually near the vaults. This particularly easily happens if the vagina is narrowed. These tears can be seen a few days after the examination, as shallow ulcers, often covered with a false membrane. Their look can be suspicious for the existence of high grade lesions, especially if there is no information on the recent examinaton. Then, symmetrical arrangement and the appearance of the changes can indicate their origin.
Condyloma
Condylomas on the vagina, as well as in other parts of the lower genital system, can be seen as papilomatous projections of different size. Squamous epithelium is organized in a very complex papillary folds, which have cores formed of connective tissue and blood vessels. Colposcopy identifies red papillary changes, rough surface or leukoplakia.
Polyp
Polyp is a benign tumor originating from columnar epithelium. It is rarely seen in the vagina. Histologically vaginal pedunculated lesions are usually papillomas originating from squamos epithelium and presenting with a papillary morphology. They may be visible with naked eye. All polyps should be excised and submitted to histopathological examination to rule out the rare occurrence of malignancy.
Cyst
Gartner's cyst (sometimes incorrectly referred to as vaginal inclusion cyst) is a benign vaginal cystic lesion that arises from the vestigial remnant of a mesonephric duct or Gartner's duct. This duct is present during embryonal life, but most often disappears after birth. If parts of the duct remain, they may collect fluid and develop into a vaginal wall cyst later in life.
Gartner's cyst is typically small asymptomatic cysts that occur along the lateral walls of the vagina, following the course of the duct. It can, however, enlarge to substantial proportions and be mistaken for urethral diverticulum or other structures.
Endometriosis
Endometriosis is the presence of endometrial tissue in locations outside of the uterus, including the vagina. Although the exact pathogenesis of endometriosis in the vagina remains speculative, implantation of the endometrial tissue is the most likely mechanism. Endometriosis can typically be seen in the scar of episiotomia.
On colposcopy, endometriosis may appear as an ulcer or a blue-domed cyst.
Inflammation
Inflammation may be the result of physical and chemical trauma or infection. It is characterized by hyperemia and a vascular pattern which is colposcopically similar to punctations. Erosions, ulcerations and necrosis may be seen in severe inflammation. During the healing the lesions are repaired and necrotic tissue is eliminated.
Vaginal stenosis
Vaginal stenosis can be congenital or acquired, caused by neoplasia, previous surgery on the lower genital organs (vaginoplasty, scars), irradiation or severe atrophia. Pelvic tumors can also produce external compression the vaginal walls narrowing the lumen of the vagina. Some dermatologic diseases such as Lichen planus may result in stenoss or even complete obliteration of vagina.
Congenital transformation zone
Sometimes there is a congenital variation of normal development of the vaginal epithelium when remnants of columnar epithelium may spread from the cervix to the upper parts of the vagina, usually in the anteroposterior line. In these fields squamous neoplasia will happen, similar to that described in the cervix. This metaplasia creates congenital aceto-white changes known as a Congenital transformation zone. This is very rare and occurs in only about 2.5% of women.
