Dear Alice,

I would like to ask why there is no reference to cancer of the vulva on your site. It directly affects sexual health. It's a neglected subject and it's hard to understand why everyone ignores it. This issue needs to be brought out into the open and obtain public support. Why isn't that happening on your site? Is it discrimination? You mention everything else!

Dear Reader,

Vulvar cancer is a neglected health topic, in part because it is very rare (accounting for less than one percent of all cancers occurring in females). Of all of the questions asked here since 1993, no one has inquired about this subject yet. Thank you for the opportunity to respond.

Education about vulvar cancer is critical, because early detection dramatically improves chances of survival. When vulvar cancer is detected in its early stages, before it has spread to the lymph nodes, the five-year survival rate is 90 percent. This number drops to 50 to 70 percent when the cancer has spread to the lymph nodes.

Although cancer of the vulva can include malignancies growing anywhere on the external female genitalia, vulvar cancer is most often found on the inner edges of the labia minora or majora (the inner or outer lips of the vulva, respectively) or the clitoris. In early stages, cancerous growths on the vulva can appear as pink, red, or white bumps that look similar to warts or rough patches of skin. Other signs that need to be checked by a gynecologist include:

  • Growths on or near the opening of the vagina
  • Rashes, warts, or sores that won't heal
  • Unusual genital itching, burning, pain, bleeding, or discharge
  • Color changes or irritation of the skin around the vagina that lasts longer than two weeks

The exact cause(s) of vulvar cancer is unknown, but it's more common in females who have HPV (human papillomavirus, which can cause genital warts) or HIV/AIDS. Older females are also at increased risk, as are those who have a history of other genital cancers, smoking, lichen sclerosis (a disorder that can cause the vulvar skin to become thin, white, crinkly, and itchy), or melanoma or unusual moles on non-vulvar skin. Hypertension, diabetes mellitus, and obesity coexist in up to 25 percent of vulvar cancer patients, but aren't considered independent risk factors. Those who do have risk factors for, or are worried about, vulvar cancer may want to discuss these risks with their health care provider. Getting an annual pelvic exam that includes an inspection of the external genitalia for any discoloration or skin changes is also a good idea, particularly if you have had a history of abnormal pap smears.

If the presence of vulvar cancer is confirmed by a biopsy (the removal and examination of a tiny piece of affected tissue), treatment options typically include surgical removal of the affected parts, and radiation or chemotherapy. If large portions of the vulva need to be removed, reconstructive surgery can help to reshape the affected areas.

If you have any concern about symptoms or risk factors you may want to visit your health care provider. For more details, you can look up the Women's Cancer Network, an interactive website founded by the Gynecologic Cancer Foundation that offers information and support to women with vulvar and other gynecologic cancers, and to their families. It also provides a questionnaire to help evaluate and reduce risk for gynecological cancers.


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