Due to its location, vaginal cancer doesn’t usually cause changes that you can see. Later stage vaginal cancer occasionally causes a mass deep inside your vaginal canal up by your cervix.

In some cases, you may feel a lump during an internal self-exam or other forms of vaginal penetration, explained Shannon A. Tomita, MD, a gynecologic oncologist with Atlantic Health System in New Jersey.

But it’s more likely that you won’t notice anything at all. Your healthcare professional, however, may be able to identify these changes during a pelvic exam.

Vaginal cancer can cause visible symptoms around your vaginal opening and inside your vaginal canal. These include:

  • nodules (flat, skin-like lumps)
  • ulcers (sores)
  • wart-like growths

Vaginal cancer can also cause unusual vaginal bleeding and unexpected changes in the color, texture, or amount of vaginal discharge.

While these symptoms don’t link with visual changes to your vagina, they may be detectable by looking at your toilet paper or your underwear’s gusset.

Many people don’t experience any symptoms during the early stages of vaginal cancer, said Damian P. Alagia, MD, the senior medical director for advanced diagnostics and women’s health at Quest Diagnostics.

When symptoms do occur, Tomita noted that “the most common symptom of vaginal cancer is vaginal bleeding.”

Spotting between menstrual cycles is common for premenopausal folks and is generally not cause for concern.

However, “postmenopausal bleeding is never normal and requires a visit to a healthcare professional,” explained Tomita.

Outside of spotting, early stage vaginal cancer can cause:

  • pain during penetrative sex
  • bloody urine or stool
  • unusual or foul-smelling discharge

Vaginal cancer spread outside your pelvis to other body areas can cause:

  • pain during urination
  • constipation
  • frequent urge to urinate
  • lower abdominal, pelvic, or back pain
  • edema (swelling in your legs)

The two main risk factors for developing vaginal cancer are high risk human papillomavirus (HPV) infections and older ages, particularly ages 60 years and older, said Alagia.

Indeed, the average age at diagnosis is 69 years old. The cancer is rare in people under 40 years old.

Also, specific HPV strains can link to many cancers, including anal, cervical, vaginal, and vulvar cancer.

But many people who contract HPV don’t develop vaginal cancer or other cancers.

You can take steps to help protect against higher risk HPV strains, including:

  • getting the HPV vaccine
  • using condoms and other barrier methods during partner sex
  • screening for cervical cancer at least once every 3 to 5 years

Not only is vaginal cancer exceedingly rare, but it often doesn’t cause noticeable symptoms. When visual changes are present, they’re often subtle or resemble the symptoms of common infections.

Tomita emphasized that if you’re experiencing new or unusual genital symptoms, make an appointment with a healthcare professional. Prompt diagnosis and treatment can help reduce the risk of long-term complications.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.