Precancer in the Vulva

Vulvar intraepithelial neoplasia (VIN) is a precancerous change in your vulva. VIN is not cancer, but if it's not treated it can turn into cancer. Intraepithelial means that the pre-cancer cells are only on the surface of the vulvar skin.

Another name for VIN is dysplasia. This term isn't used as much anymore.

The last stage of VIN before invasive cancer is called carcinoma in situ. The cell changes become more serious as they progress toward cancer. But this process may take many years. This is why regular health checkups are important. Finding and treating VIN can keep it from becoming cancer.

The vulva is the outer part of the female reproductive system. It’s also called the external genitalia. The vulva includes:

• Mons pubis. This is the rounded area in front of the pubic bones. It becomes covered with hair at puberty. It includes the skin folds under the pubic hair that protect the opening of the vagina and the urethra. The urethra is the tube that carries urine out of the body.

• Labia majora. The outer folds of skin on each side of the vulva.

• Labia minora. The inner folds of skin on each side of the vulva.

• Prepuce or hood of the clitoris. This is made by the top of the inner folds of the vulva where the labia minora meet.

• Clitoris. This is below the prepuce. It’s a sensitive piece of tissue that swells with blood when stimulated.

• Fourchette. This is where the labia minora meet at the bottom of the inner folds of the vulva.

Perineum. The area between the fourchette and the anus.

VIN often does not cause symptoms. So, most women do not know they have it. These may be signs of VIN:

• Mild to severe itching or burning on the vulva that doesn't go away.

• Changes in the skin color on the vulva. It may be white, pink to red, gray, or dark brown.

• Thickening of the skin on the vulva.

• A lump or bump on the vulva.

• A sore or cracked skin on the vulva.

Your healthcare provider may suspect VIN after looking at your vulva, but you’ll need a biopsy to be sure of the diagnosis. A biopsy is done by taking a tiny piece of tissue from the changed part of the vulva. It's sent to a lab where it's tested for cancer or precancer cells.

VIN has been linked to cigarette smoking. Quitting smoking can reduce your risk. It also has many other health benefits. Limiting your number of sex partners and using condoms may also help reduce your risk.

If you’ve been diagnosed and treated for VIN, pay close attention to your body. Do regular self-exams of your vulva as your healthcare provider directs you. Also, get your checkups. Tell your healthcare provider if you have pain or burning in your vulva or if you have any skin changes.

Getting regular pelvic exams can reduce your risk of vulvar cancer. VIN develops slowly. Regular checkups mean your healthcare provider can find VIN while it’s small and easier to treat. Finding and treating VIN early helps reduce the chance that the changed cells will progress to cancer.

VIN should be treated or followed by a specialist who deals with vulvar diseases.

Treatment is used to destroy or remove all of the precancer cells. Surgery is often used to cut out the changed area of skin and an edge of normal tissue around it. This is done to help be sure that all the changed cells have been removed. Another option might be laser treatments to burn out the VIN cells.

In some cases, a topical medicine can be put right on the changed skin of the vulva. Medicines used include imiquimod or fluorouracil (5-FU). This may be called topical chemotherapy.

The type of treatment used and the long-term changes to the vulva depend on many factors. These include the type of VIN, where it is on the vulva, and the size of the changed area. Your preferences are also important. Talk with your healthcare provider about your treatment options so you can make the choice that's best for you.

If you have questions about VIN or your risk for vulvar cancer, talk with your healthcare provider. He or she can help you understand more about this precancer and what it means for you.