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This information is about a skin condition called vulval intra-epithelial neoplasia or VIN, which can affect the vulva and, in some women, may develop into cancer after many years.
The vulva is a woman's external genital area. It includes two large, hair-covered folds of skin called the labia majora, which surround two thin and delicate folds called the labia minora. The labia majora and labia minora surround the opening of the vagina and the tube through which urine is passed (the urethra).
The clitoris is positioned above the vagina and urethra. This small structure is very sensitive and helps a woman reach sexual climax (orgasm). The opening to the back passage (anus) is separated from the vulva by an area of skin called the perineum.
The vulva
View a large copy of the diagram of the vulva |
The term VIN refers to particular changes that can occur in the skin that covers the vulva. VIN is not cancer, and in some women it disappears without treatment. If the changes become more severe, there is a chance that cancer might develop after many years, and so it's referred to as a pre-cancerous condition.
Although VIN used to be quite rare, it's now being recognised and diagnosed more frequently. It can affect women of any age from the 20s onwards.
VIN is divided into two types depending on its characteristics.
Nearly all VIN is of this type. It is more common in younger women aged 35–55. It includes VIN, warty type; VIN, basaloid type; and VIN, mixed (warty, basaloid) type.
This type is much rarer and is more common in older women aged 55–85. It can often occur alongside other skin conditions that can affect the vulva, such as lichen sclerosis.
VIN is graded depending on how abnormal the cells look when examined under a microscope. The grade gives an idea of how quickly the cells may develop and can help the doctor decide on the best treatment. The grades are:
The cells look more abnormal than grade 1, but not as abnormal as grade 3.
The cells look very abnormal. They are likely to grow more quickly.
Usual type VIN is associated with an infection in the skin of the vulva by a virus known as human papilloma virus (HPV)|. HPV is a very common infection. There are more than 100 types of the virus, and the most common types (known as low-risk HPV) can cause warts on the skin of the hands or verrucas on the feet. Other types can cause cell changes in the genital area, including the cervix, vulva and anus. These types of HPV are known as high-risk HPV.
Genital HPV infection is spread by direct skin-to-skin contact during sex with someone who has the infection. HPV is so common that most sexually active women will be exposed to it at some time in their life. In most women, their body's own immune system will get rid of the HPV naturally, without them ever knowing it was there.
Not all women who have HPV will develop VIN. Differentiated type VIN is not associated with an HPV infection.
Other factors that depress the body's immune system can also increase the risk of VIN. These include smoking, particular medicines (such as those taken after transplant surgery), inherited immunity problems, and some rare bone marrow and blood disorders.
The signs and symptoms of VIN vary and may include some, or all, of the following:
Rarely, no symptoms are apparent, and some women are diagnosed with VIN while having medical tests for other health problems. If you do have any of the above symptoms let your doctor know. Your doctor can then examine you and refer you to a doctor who specialises in women's health (a gynaecologist). However, the above symptoms can be caused by conditions other than VIN.
Your doctor will examine the vulval area and may use a special microscope (a colposcope), which magnifies the area so that any changes can be clearly seen. A small sample of cells from the affected area will be taken for examination under a microscope (biopsy). A local anaesthetic cream is usually used before the biopsy is taken. Once it has been applied it usually takes around 20 minutes to numb the vulval area before the biopsy is taken. Liquid anaesthetic is then injected into the area, using a small needle. Sometimes a general anaesthetic may be given. A sample of cells is then taken from the vulva, using a biopsy tool.
The doctor may also examine the cervix and vaginal walls to look for any abnormalities in the cells.
VIN is not cancer, but it causes changes to the cells of the vulva. If the cell changes are mild, treatment may not be needed, but you will need to have the area checked regularly by your doctor.
Treatment may be needed for grade 2 or 3. The type of treatment most appropriate for you will depend on:
If you smoke, giving up can help strengthen your immunity, make the treatment more effective, and reduce the chance of the VIN coming back after treatment.
In certain situations, it may be possible to delay treatment for a period of time (for example, if you're pregnant). In this situation the VIN would be closely monitored for any changes.
In women who need treatment, most will have the affected area removed with surgery| known as local surgical excision. Rarely, if the affected areas are large or there are several areas, the whole vulva may be removed in a vulvectomy. Sometimes the vulval tissue can be replaced with skin taken from another part of the body (a skin graft).
Laser ablation treatment may be used for areas where it's difficult to remove the VIN, such as around the clitoris. A high-energy laser beam is focused on the affected areas to destroy the abnormal cells.
Before any treatment, it's important that you know exactly how much skin is going to be removed and how this will affect you afterwards. Your specialist can discuss this with you before you have the treatment.
The following treatments may sometimes be used:
A tiny electrical current is passed through a probe, which is used to cut out or destroy the affected areas. A colposcope is used to identify these areas.
The steroid| cream is applied to the affected areas. It reduces inflammation and can control symptoms, but doesn't cure the condition.
Other possible treatments for VIN are being investigated. They are experimental at the moment and include:
There is a risk that VIN can come back after treatment, so you will be seen regularly by your specialist, often for many years. Your doctors will check for signs of any further changes that may need to be treated. If there is only a small chance of your VIN returning, your specialist may discharge you into the care of your GP.
If you notice any new symptoms or changes, it's important to let your GP know so that you can be referred back to your hospital specialist.
Many women feel frightened when they are first told they have VIN and worry that they may develop cancer. You may find the treatments both embarrassing and upsetting, and may feel tense, tearful or withdrawn. At times, these feelings| can be overwhelming and hard to deal with.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to friends or family, while others prefer to seek help from people outside their situation. Others may prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available| if you need it.
Vulval Pain Society| is a voluntary organisation run by a doctor and nurse that gives information and support to women with any vulval condition.
This information has been compiled using information from a number of reliable sources including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.