bleeding in vaginal mucosa

I am a 52 year old female with no children. I am not sexually active. A year ago I had a supracervical laparoscopic hysterectomy with salpingo oopherectomy. I had the surgery because I had been spotting for two years due to endometrial hyperplasia and various hormonal treatments and a D and C and hysteroscopy with removal of 2 polyps didn't help.I spotted for 6 months after the surgery,stopped spotting for 7 months, and then began spotting again for the past seven weeks. I had my annual gynecological exam September 17, and the doctor said the spotting was caused by bleeding in the right vaginal mucosa. He seemed to think this was unusual and shouldn't be happening. He stopped the bleeding with silver nitrate but told me to come in immediately if I had any more spotting. He of course did a pap smear. Of course I immediately asked about vaginal cancer. He said he didn't see any lesions and that vaginal cancer was not that common. Of course I am worried. I will have my pap smear results in a week to ten days but I need some answers now. Any thoughts about what might be going on? Thanks.

[Kevin Pho, MD]

Vaginal cancer occurs in 2 percent of cancer cases of the female genital tract.  The majority of patients with vaginal carcinoma present with vaginal bleeding, either postmenopausal or postcoital. Other symptoms include a watery, blood-tinged, or malodorous vaginal discharge, vaginal mass, urinary symptoms (eg, frequency, dysuria, hematuria), or gastrointestinal complaints (eg, tenesmus, constipation, melena).

The diagnosis of vaginal carcinoma can be difficult.  Papanicolaou (Pap) smear may detect malignant cells; 20 percent of vaginal tumors are detected incidentally as a result of cytologic screening for cervical cancer.

Definitive diagnosis is accomplished by biopsy of the suspected lesion, which may appear as a mass, a plaque, or an ulcer. If a lesion is not visualized in the presence of abnormal cytologic results, colposcopy of the cervix should be considered.

I would suggest a biopsy if the PAP smear returns negative.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Elkas et al.  Vaginal cancer.  UptoDate, 2003.