Vaginal cancer is rare. It accounts for just 1% to 2% of all cancers in the female genital tract, making it one of the least common gynecological cancers. Most women will never encounter this diagnosis personally, but understanding the numbers, risk factors, and outlook can help put the disease in perspective.
How Rare Is Vaginal Cancer?
Among cancers that affect the female reproductive system, vaginal cancer sits at the very bottom of the list. Cervical, uterine, and ovarian cancers are all far more common. Vaginal cancer also represents a very small portion of all cancers overall, which means many gynecologists will see only a handful of cases across an entire career.
The rarity of this cancer has practical implications. It means large clinical trials are harder to conduct, and treatment guidelines often draw on smaller studies and clinical experience. It also means that if you or someone you know receives this diagnosis, finding a specialist with specific experience in vaginal cancer is important.
Who Gets Vaginal Cancer
Vaginal cancer is overwhelmingly a disease of older women. Risk rises steadily with age, and the vast majority of cases are diagnosed after 55. Among new cases, the age breakdown looks like this:
- Under 45: roughly 7% of cases
- 45 to 64: about 30% of cases
- 65 and older: more than 60% of cases
Diagnosis before age 20 is extremely uncommon, accounting for about 0.1% of cases. That said, younger women are not completely immune, particularly those with certain risk factors like HPV infection.
The Role of HPV
Human papillomavirus (HPV) is the single biggest risk factor. Approximately 78% of vaginal cancers are linked to high-risk strains of HPV, the same virus responsible for most cervical cancers. HPV is extremely common and usually clears on its own, but in some cases a persistent infection can cause cells in the vaginal lining to change and eventually become cancerous, often over many years.
This connection to HPV means the HPV vaccine, widely available for adolescents and young adults, has the potential to prevent a large share of vaginal cancers. Routine cervical screening (Pap tests and HPV tests) can also catch precancerous changes in the vaginal area, especially in women who have had a hysterectomy for HPV-related conditions.
Types of Vaginal Cancer
Between 80% and 90% of vaginal cancers are squamous cell carcinomas, which start in the thin, flat cells lining the vaginal surface. These are the type most strongly tied to HPV. Adenocarcinoma, which begins in glandular cells, is much less common. Melanoma accounts for about 3% of vaginal cancers, and sarcomas (which arise from muscle or connective tissue in the vaginal wall) are rarer still.
One historically notable form is clear cell adenocarcinoma, linked to in utero exposure to a drug called DES (diethylstilbestrol). DES was prescribed to pregnant women from the 1940s through the early 1970s to prevent miscarriage. Women whose mothers took DES during pregnancy face about 40 times the normal risk of developing clear cell adenocarcinoma of the vagina or cervix. Early cases appeared in very young women, sometimes in their teens, though research has shown the elevated risk persists into the 40s and 50s. Because DES was discontinued decades ago, this particular risk factor is largely fading from the population, but women born before 1971 who know they were exposed should be aware of it.
Survival Rates by Stage
Because vaginal cancer is rare, survival data comes from relatively small numbers, but the overall five-year relative survival rate across all stages is about 55%. That number varies enormously depending on how far the cancer has spread at the time of diagnosis.
- Localized (confined to the vagina): 76% five-year survival
- Regional (spread to nearby tissues or lymph nodes): 59% five-year survival
- Distant (spread to organs farther away): 24% five-year survival
These figures are based on women diagnosed between 2015 and 2021. They reflect averages across many patients and don’t account for individual factors like overall health, the specific type of vaginal cancer, or how well the cancer responds to treatment. Early detection clearly makes a significant difference, which underscores why unusual vaginal bleeding (especially after menopause), persistent discharge, or a mass felt during an exam should be evaluated promptly.
Why Early Symptoms Are Easy to Miss
Part of what makes vaginal cancer tricky is that early-stage disease often produces no symptoms at all. When symptoms do appear, the most common is abnormal vaginal bleeding, particularly bleeding after intercourse or bleeding after menopause. Other signs can include watery or blood-tinged discharge, pain during intercourse, a lump or growth in the vagina, and pain during urination.
These symptoms overlap with many far more common and benign conditions, which is one reason vaginal cancer can go undetected until it has progressed. There is no standard screening test specifically for vaginal cancer, though abnormal cells are sometimes picked up incidentally during a Pap test. Women who have had a total hysterectomy for reasons related to HPV or precancerous changes are sometimes advised to continue vaginal Pap tests, since the remaining vaginal tissue can still be affected.