Vaginal stenosis is a condition characterized by the narrowing and shortening of the vaginal canal. This alteration in the vaginal structure occurs due to the formation of scar tissue, which lacks the natural flexibility of healthy vaginal tissue. The development of vaginal stenosis can significantly impact the vagina’s ability to expand and stretch.
Understanding Vaginal Stenosis
The affected vaginal tissue may also become thinner and drier, contributing to a loss of flexibility. This structural change can lead to adhesions, where parts of the vaginal walls stick together, further constricting the canal. The reduction in blood flow to the area can also exacerbate tissue fragility and overall vaginal health.
Medical Treatments as Causes
Certain medical treatments, particularly those targeting the pelvic region, are common causes of vaginal stenosis. Radiation therapy, frequently used for cancers such as cervical, endometrial, rectal, and anal cancers, can significantly affect vaginal tissue. This treatment, whether external beam radiation or brachytherapy, damages the vaginal lining, leading to an abnormal production of collagen. This process results in atrophy, a reduction in muscle tissue, decreased blood supply, and the formation of fibrosis, which is a type of scar tissue.
The incidence of radiation-induced vaginal stenosis can vary widely, but it is recognized as a common side effect, often appearing within the first year after treatment and potentially worsening over time. Chemotherapy, sometimes administered concurrently with radiation, can also contribute to the development or worsening of vaginal stenosis.
Surgical procedures involving the pelvic area can also lead to vaginal stenosis due to scar tissue formation during the healing process. Hysterectomies, especially radical procedures that involve removal of part of the upper vagina, can result in shortening and narrowing. Other pelvic surgeries, such as those for pelvic organ prolapse or reconstructive procedures, can also cause scar tissue to form, thereby constricting the vagina.
Gender-affirming vaginoplasty, a surgery to create a vagina, carries a risk of stenosis as a common post-operative complication. The creation of a neovagina involves tissue manipulation and healing, which can lead to the formation of constricting scar tissue. Additionally, complications from childbirth, such as episiotomies or vaginal tears, can result in scar tissue that narrows the vaginal opening or canal. The body’s repair mechanism following these interventions forms scar tissue that inherently lacks the stretch and elasticity of undamaged tissue.
Inflammatory and Chronic Conditions
Inflammatory and chronic medical conditions can also contribute to the development of vaginal stenosis through persistent tissue changes and scarring. Lichen sclerosus is a chronic inflammatory skin disorder that predominantly affects the anogenital area. This condition causes the skin to become thin, white, and fragile, eventually leading to scarring and tightening. The scarring from lichen sclerosus can result in introital stenosis, which is a narrowing of the vaginal opening.
While lichen sclerosus typically involves the vulva and perianal region, it can indirectly affect the vagina by causing significant scarring and rigidity around its entrance. Other dermatological conditions, such as lichen planus, are also associated with tissue changes that can lead to vaginal stenosis. These conditions induce chronic inflammation, which, over time, promotes the formation of fibrotic tissue.
Less commonly, chronic vaginal infections, if left untreated and severe, might contribute to scarring that could result in some degree of stenosis. The prolonged inflammatory response from such infections can lead to tissue damage and subsequent fibrosis. Autoimmune reactions can also play a role, as the body’s immune system mistakenly attacks healthy tissues, leading to inflammation and eventual scarring. These disease processes are distinct from treatment-induced causes, as the underlying condition itself drives the tissue damage and subsequent narrowing.
Other Less Common Factors
Beyond medical treatments and chronic inflammatory diseases, other less common factors can contribute to vaginal stenosis. Some individuals are born with conditions that affect vaginal development, known as congenital anomalies. Vaginal agenesis, where the vagina is absent or underdeveloped, is a congenital disorder, often associated with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. In these cases, surgical creation of a vagina may be necessary, and subsequent stenosis can be a complication of the surgical healing process.
Another congenital factor is a transverse vaginal septum, a fibrous band of tissue that obstructs the vaginal canal. Surgical correction of this septum can lead to scarring and a “hourglass” effect, resulting in stenosis. Severe trauma to the pelvic area, while not a direct cause of stenosis in the same way as chronic conditions or surgery, can lead to extensive scar tissue formation. This scar tissue can then cause narrowing and rigidity of the vaginal canal.
Graft-versus-Host Disease (GVHD), a complication that can occur after bone marrow or stem cell transplantation, is another factor. In GVHD, the donor immune cells attack the recipient’s healthy tissues, including those in the genital tract. This immune reaction leads to inflammation and fibrosis, which can result in significant scarring, narrowing, and even complete obstruction of the vagina.