Differential Analysis of Factors Associated with Vaginal Lesions in Women of Different Age Groups

Yi-Fen Li,* Xiao-Hui Yang,* Wen-Wei Li, Xiao-Mao Li, Yue-Bo Yang, Min-Juan Ye Gynecology Department of the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yue-Bo Yang; Minjuan Ye, Gynecology Department of the Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong, People’s Republic of China, Email yangyueb@mail.sysu.edu.cn; yemjuan@mail.sysu.edu.cnObjective: To investigate differences in factors associated with vaginal intraepithelial neoplasia (presence/absence and grade) such as HPV, TCT results, and concurrent lesions across age groups, supporting precise prevention and screening strategies.Methods: A retrospective study included 212 patients undergoing colposcopy and vaginal biopsy (2020– 2024), grouped as < 50 years (n=88) and ≥ 50 years (n=124). Chi-square tests or Fisher’s exact test were used to compare categorical variables between groups and to analyze associations between VaIN presence and clinical factors within each age group. Spearman rank correlation was used to evaluate the correlation between VaIN grade (ordinal) and ordinal clinical factors (eg, TCT result grade, grade of previous/concurrent cervical or vulvar lesions).Results: Age < 50 years was significantly associated with VaIN occurrence (P< 0.05). In the ≥ 50 years group, TCT results more often indicated high-grade lesions (P< 0.05). Within the < 50 years group, VaIN presence/grade showed no significant association with HPV, TCT, concurrent cervical/vulvar lesions, or lesion history. In the group aged ≥ 50 years, the presence or absence of VaIN was not associated with any of the factors. However, the grade of VaIN lesions was significantly positively correlated with the grade of previous/concurrent cervical or vulvar lesions (Spearman ρ = 0.208, P = 0.020), and showed a trend toward a positive correlation with TCT result severity (Spearman ρ = 0.154, P = 0.088).Conclusion: The correlation between VaIN grade and prior lower genital tract lesions reverses with age, being negative in younger women and positive in older women. These findings underscore the necessity for age-stratified screening and management strategies for VaIN. In clinical practice, for women aged ≥ 50 years, greater emphasis should be placed on TCT screening results and the history of previous cervical/vulvar lesions.