Vulva, vagina & female urethra


Vaginal adenosis

Topic Completed: 1 March 2003

Minor changes: 19 October 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Adenosis vagina [title]

Nat Pernick, M.D.
Page views in 2020: 1,103
Page views in 2021 to date: 1,613
Cite this page: Pernick N. Vaginal adenosis. website. Accessed October 15th, 2021.
Definition / general
  • Müllerian type glandular epithelium in vagina, seen in 41% of postpubertal females at autopsy vs. 0% prepubertal
  • May present with excess mucus
  • Adenosis present in 35% to 90% after in utero exposure to DES, taken by pregnant women until 1971 in USA (100% have adenosis if DES started before gestational week 8, 6% if started week 15 or later)
  • DES adenosis is similar histologically to non-DES adenosis
  • Mouse model of DES exposure demonstrates vaginal adenosis and structural changes similar to actual changes observed in women (Hum Pathol 1982;13:190)
  • Risk of subsequent clear cell adenocarcinoma is increased but very small
Clinical features
  • Transverse ridges: aka cockscomb cervix, rims, collars, hoods, pseudopolyps; in upper vagina or cervix of 25% of women with DES exposure
  • DES related VAIN: DES related VAIN I lesions usually regress after therapy or biopsy but VAIN II / III lesions tend to persist and recur after biopsy or therapy (are often aneuploid)
  • Non-DES related adenosis: median age 44 years, range 24 to 88 years, 15% symptomatic; similar microscopic appearance to DES related adenosis (Hum Pathol 1986;17:488)
Gross description
  • Red granular spots or patches that do not stain with Lugol iodide solution
Microscopic (histologic) description
  • Endocervical type mucous glands on vaginal surface or in lamina propria, often presenting as cysts or nodules
  • Tuboendometrial cells and embryonic columnar cells between lamina propria and squamous epithelium
  • Intestinal metaplasia rare
  • Often chronic inflammation and squamous metaplasia (may be extensive and obliterate glandular lumina, may resemble dysplasia / VAIN)
  • Microglandular hyperplasia present if patient using oral contraceptives
  • Transverse ridges: fibrous tissue lined by mucinous epithelium or metaplastic squamous epithelium; rarely tubal or endometrial epithelium
Positive stains
Cytology description
  • May be detected in vaginal smears if present on vaginal epithelium
Differential diagnosis
  • Clear cell carcinoma: if microglandular hyperplasia present
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