Vulvar Cancer: The Cancer Too Many Women Are Too Embarrassed to Mention

Introduction

Vulvar cancer is rare compared to cervical, breast, or ovarian cancer, but I’m writing about it because it’s the one I see arrive latest — not because it’s hard to detect, but because it’s hard for women to talk about. The vulva (the external genital area) is a part of the body many women rarely examine and rarely feel comfortable mentioning, even to a doctor. That silence is often the real delay, not the disease itself. I want to say clearly: nothing you notice down there is too embarrassing to bring up with your gynecologist. That’s exactly what we’re here for.

By Dr. Ramya D R, Gynaecological Oncologist

Who’s at higher risk

Vulvar cancer most often affects women after menopause, typically in their 60s and 70s, but it is increasingly being diagnosed in younger women too, largely tied to HPV. Key risk factors include:

HPV infection. The same high-risk HPV strains linked to cervical cancer are responsible for a significant proportion of vulvar cancers, especially in younger women. HPV vaccination, discussed in our cervical cancer article, offers some protection here as well.

Chronic vulvar skin conditions, particularly lichen sclerosus — a condition causing persistent itching, thinning, and whitening of the vulvar skin. It’s common, very treatable, but if left unmanaged over years, carries a modestly increased risk of vulvar cancer. If you’ve been diagnosed with lichen sclerosus, regular follow-up matters, not just symptom relief.

Vulvar intraepithelial neoplasia (VIN) — precancerous cell changes in the vulvar skin — is a direct precursor in many cases and is itself treatable when caught early.

Smoking significantly increases risk, particularly in combination with HPV infection.

A history of cervical or vaginal cancer, or a weakened immune system, also raises risk and may warrant closer follow-up of the vulvar area during your regular visits.

Why awareness matters more than screening here

There is no routine screening test for vulvar cancer — no equivalent of a Pap smear. This makes two things especially important: regular gynecological examinations, where your doctor visually checks the vulva as part of a routine pelvic exam (please don’t skip this part or feel that it’s unnecessary), and your own familiarity with your body. You don’t need to perform a formal self-exam ritual — just enough general awareness to notice if something looks or feels different than it used to.

If you have lichen sclerosus or a prior diagnosis of VIN, ask your doctor how often you should be specifically checked, since your surveillance needs are different from a woman without that history.

Warning signs — and when to see a doctor

Please see a gynecologist if you notice any of the following, particularly if it persists beyond 2–3 weeks:

Persistent itching of the vulva that doesn’t resolve with usual measures
A lump, wart-like growth, or thickened patch of skin
A sore, ulcer, or area that doesn’t heal
Changes in vulvar skin color — patches that are red, white, or darker than surrounding skin
Bleeding that isn’t related to your period
Pain, burning, or tenderness in the vulvar area, including during urination or intercourse
Any mole on the vulva that changes in size, shape, or color

Persistent itching is, by far, the most common early symptom — and also the most commonly dismissed, often for months or years, as a minor irritation, an allergy, or something to simply live with. Most vulvar itching is not cancer; infections, dermatitis, and lichen sclerosus are far more common causes. But because these benign conditions and early vulvar cancer can look and feel similar, the itching itself isn’t something to self-treat indefinitely without ever having it examined.

You don’t need to feel embarrassed

I say this to my patients often, and I mean it here too: I have had this conversation more times than you can imagine, about parts of the body more times than you can imagine. There is nothing you could describe to me that would surprise or embarrass me — that’s true of every gynecologist you’ll meet. What does concern me is the woman who lives with a symptom silently for a year because she couldn’t bring herself to say the words out loud.

If something has changed, if an itch won’t quit, or if it’s simply been a while since your last full gynecological exam, please come in. This is a conversation worth having early, in a room where nothing is too awkward to say.