The vagina is a tubular structure consisting of muscles and membranes. The vagina forms the passageway between the cervix uteri and the vulva.

Disease of or injury to the vagina may be caused by cancer, genetic disorders, loss of estrogen after menopause, or vaginismus. Additional causes may be related to a change in the normal vaginal pH, vaginal infections, hormone replacement therapy (HRT), antibiotic therapy, multiple sexual partners, sexually transmitted diseases (STDs), foreign objects (such as a pessary) left in place for a prolonged period, and chronic skin disorders. Infection due to poor hygiene; use of hygiene sprays and perfumes; bath water additives; laundry chemicals; tight underclothing; sensitivity to contraceptives; as well as frequent douching with irritants, such as iodine, may also be contributing causes. Deficiencies in estrogen due to surgery, radiation or chemotherapy may increase the chance of trauma or infection. Other causes may be fistulas, viruses, polyps, pinworms, or biologic conditions, such as diabetes mellitus.

Signs and symptoms may vary depending on the cause, and may include pale vaginal mucosa, or loss of rugae. The vaginal surface may be dry, shiny, cracked and have decreased elasticity. Signs and symptoms may also include: itching, burning, pain, redness, swelling, excoriation, vaginal tenderness, blisters, abnormal and malodorous discharge, fever, dysuria, abnormal vaginal bleeding, or watery or bloody discharge. There may be lesions, such as warts, cysts, or lumps. Pain with intercourse may be present depending on the cause of the inflammation or infection. With genetic disorders, there may be little or no vagina, or the vagina may be very short with no cervix.

A complete history, physical and pelvic examinations, biopsy of lesions, measurement of the pH, wet mounts for microscopic examination, cultures, laboratory studies, and papanicolaou (PAP) smear may be included in the testing. Endoscopy and x-ray may be done to assist in the staging of cancer.

Oral or topical medications may be given for the specific organism, and to treat symptoms. Occasional warm water douching, sitz baths, and re-education regarding personal hygiene may be indicated. Surgery may be needed to correct vaginal abnormalities. Depending on the cause, other treatments may include hormone replacement therapy, or vaginal dilatation in conjunction with psychotherapy. In the event of cancer, radical removal of the tumor and radiation therapy may be indicated.

Oral or topical medications may be given for the specific organism, and to treat symptoms. Occasional warm water douching, sitz baths, and re-education regarding personal hygiene may be indicated. Surgery may be needed to correct vaginal abnormalities. Depending on the cause, other treatments may include hormone replacement therapy, or vaginal dilatation in conjunction with psychotherapy. In the event of cancer, radical removal of the tumor and radiation therapy may be indicated.

• Prior the change in the rating schedule on May 13, 2018, female sexual arousal disorder (FSAD) was evaluated analogously to this diagnostic code (7699-7611).

• Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.
• When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to 38 CFR 3.350 to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in 38 CFR 4.116 might, under certain circumstances, establish entitlement to special monthly compensation.