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 isn't a commonly discussed health topic, in part because it’s very rare (accounting for less than one percent of all cancers occurring in individuals with vulvas). Of all of the questions asked on this website since 1993, this is the first received about this subject. Thank you for the opportunity to respond.

First, it can be helpful to know what exactly the vulva is. The vulva includes all the external genitalia of those assigned female at birth, which contains the labia minora and majora (the inner or outer lips of the vulva, respectively), the clitoris, the perineum, and the anus. Although cancer of the vulva may include malignancies growing anywhere on the external genitalia, it’s most often found on the inner edges of the labia minora or majora or the clitoris. In early stages, cancerous growths may appear as pink, red, or white bumps that look similar to warts or rough patches of skin. Other potential signs of vulvar cancer 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, tenderness, bleeding, or discharge
  • Painful urination
  • Color changes or irritation of the skin around the vagina that lasts longer than a few weeks

The exact cause(s) of vulvar cancer is unknown. That being said, it's more common among individuals who have human papillomavirus (HPV), which may cause genital warts, and those with human immunodeficiency virus (HIV). Older individuals with vulvas are also at increased risk as the average age of diagnosis is 65 years old. Individuals who have a history of other genital cancers, smoking, lichen sclerosis (a disorder that may cause the vulvar skin to become thin, white, crinkly, and itchy), melanoma, or any unusual moles on non-vulvar skin are also at an increased risk.

If you or someone you know has risk factors for, or are worried about, vulvar cancer, it may be good to talk with your health care provider. Getting an annual pelvic exam that includes an inspection of the external genitalia for any discoloration or skin changes is also recommended, particularly if you’ve had a history of abnormal Pap smears. During a pelvic exam, you may also have a biopsy of the vulvar tissue, which is then viewed under a microscope to check for pathology (abnormality of the cells). If the biopsy shows there is vulvar cancer, 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 may help to reshape the affected areas.

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 spreads to the lymph nodes, the five-year survival rate is about 86 percent. This rate drops to about 53 percent when the cancer has spread to the lymph nodes and to less than 20 percent when the cancer has spread to more distant parts of the body. For more details, consider checking out the American Cancer Society to learn more about this and other cancers. You can also read some of the Q&As in the Cancer category of the Go Ask Alice! General Health archives to learn more, including how to support others who may have been diagnosed with cancer. Kudos to you for asking the key questions!

Alice!

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