Vulval cancer

If you were born with a vulva, you are at risk of vulval cancer. This is relevant to you if you’ve not undergone gender-affirming genital surgery, or if you’ve had a phalloplasty or a metoidioplasty (both sometimes referred to as bottom surgery), as part or all of the vulval tissue remains after these procedures.

Vulval cancer is one of the rarer gynae cancers and affects around 1400 people a year in the UK.

Around 80% of people diagnosed are over 60, but we are seeing more people being diagnosed at a younger age.

The vulva describes the external genitals, including the soft tissue (labia minora and labia majora), the clitoris, and the Bartholin’s glands.

Symptoms

• A lasting itch on the external genitalia
• Pain or soreness on the external genitalia
• Thickened, raised, red, lighter or darker patches on the skin of the vulvaAn open sore or growth visible on the genital skin
• A mole on the external genitalia that changes shape or colour
• A lump or swelling on the external genitalia

All these symptoms can be caused by other more common conditions, such as infection, but if you have any of these, you should see your GP. It is unlikely that your symptoms are caused by a serious problem but it is important to be checked out… remember non-cancerous conditions can be uncomfortable and so much better when treated!

Risk Factors

We don’t often know exactly what causes a vulval cancer, but there are some factors that increase your risk:

Vulval intraepithelial neoplasia (VIN)

VIN is a pre-cancerous condition. This means there are changes to the cells on the surface of the vulval skin. These cells aren’t cancer but could develop into cancer at a later date if they don’t clear on their own or are treated. This is a gradual process that can take many years.

Symptoms of VIN are similar to vulval cancer. If you have any of these symptoms, go and see your GP. Sometimes, people don’t have any symptoms and VIN is detected when they are being examined for another reason.

There are two types of VIN:

• Usual or undifferentiated VIN – this typically affects people under 50 and is thought to be caused by a HPV infection.
• Differentiated VIN (dVIN) – this is a rarer type, usually affecting people over 60 and linked to other vulval skin conditions such as lichen sclerosus. There is a higher risk of this type developing into a cancer.

Human papilloma virus (HPV)

HPV is a group of common viruses that are spread through skin-to-skin sexual contact, there are estimated to be more than 200 different types.

Most of us will come into contact with HPV at some time during our lives, and usually our immune system can clear the virus on its own without it causing any problems.

If HPV doesn’t clear and isn’t treated, it can sometimes develop into cancer. Almost 7 in 10 vulval cancers are linked to a HPV infection.

Skin conditions

Several skin conditions can affect the vulva, including lichen sclerosus, lichen planus and pagets disease of the vulva. In a small number of cases these are associated with an increased risk of vulval cancer.

Smoking

Smoking increases your risk of developing VIN and vulval cancer. This may be because smoking makes the immune system less effective and less able to clear the HPV virus.

Information updated: November 2024. Next review due: November 2027