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3. Major risk factors: smoking immunosuppression organ transplantation HIV infectionCigarette smoking, nutritional deficiency, poor personal hygiene, granulomatous vulvar diseases, systemic immune suppression HIV 3www.zohrehyousefi.com

4. VAIN tends to be multifocal Diagnosis: Four walls from the apex to the introitus as sequential steps sterilized skin-hook for traction at the biopsy site. Small skin hooks and dental mirrors 4www.zohrehyousefi.com

5. Diagnosis: careful inspection handheld magnifying glass Vaginal biopsy 5www.zohrehyousefi.com

6. Diagnosis: Pap smears from different locations in the vagina Lugol solution may be helpful in delineating lesions Colposcopic examination of the vagina 6www.zohrehyousefi.com

7. postmenopausal, local use of estrogen creams for several weeks 7www.zohrehyousefi.com

8. 1. Indications for Vaginal Colposcopy 2.Abnormal cytology after apparently successful treatment of CIN 3.Abnormal vaginal vault cytology post hysterectomy 4.Abnormal cytology al the presence of colposcopically normal cervix, particularly if colposcopy is satisfactory 5.Confirmed high-grade CIN in an immunosuppressed patient 8www.zohrehyousefi.com

9. 1.Confirmed diagnosis of high-grade vulvar intraepithelial neoplasia 2.Abnormal gross vaginal examination 3.Diagnosis and treatment of multicentric human papillomavirus infection, particularly if recalcitrant to conservative treatment 4.CIN 9www.zohrehyousefi.com

10. VAIN pathology Management: Local excision upper colpectomy Total vaginectomy 10www.zohrehyousefi.com

11. VAIN pathology outpatient modalities Cryosurgery (5-FU) cream chemoinflammation and chemoulceration Every night for 5–8 days, followed by a 10- day to 2-week cavitational ultrasonic surgical aspirator 11www.zohrehyousefi.com

12. imiquimod cream once weekly for 3 weeks.. antiviral and antitumor 12www.zohrehyousefi.com

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