Vulval Cancer Symptoms, Risks, and Seeking a UK Diagnosis

Vulval cancer is a rare type of cancer that affects the vulva—the external parts of the female genitals. This includes the labia (lips), the clitoris, and the Bartholin’s glands. While it accounts for less than 1% of all cancers in women in the UK, it is vital to remain aware of the symptoms, particularly as we age. Most cases are diagnosed in women over the age of 65, though it can occur in younger individuals as well.

According to NHS guidance, there are several types of vulval cancer, with squamous cell carcinoma being the most common. Other rarer forms include vulval melanoma and verrucous carcinoma. Because the symptoms often mimic common conditions like thrush or dermatitis, many patients delay seeking a medical opinion. Understanding what is 'normal' for your body is the first step in proactive health management.

Symptoms of vulval cancer can vary depending on the type and stage, but the most common signs reported by UK patients include:

• A persistent itch: Itching that does not resolve with standard over-the-counter treatments for thrush or eczema.
• A visible lump or swelling: A growth that may be firm, lumpy, or look like a wart.
• Skin changes: Patches of skin that appear thicker, paler, or redder than the surrounding area.
• Soreness or pain: Tenderness in the vulval region that persists for several weeks.
• Bleeding or discharge: Any bleeding that is not related to your period, or unusual discharge.
• An open sore: An ulcer or sore that does not heal within a few weeks.

It is important to note that many of these symptoms are frequently caused by non-cancerous conditions, such as lichen sclerosus or vulval dermatitis. However, NICE (National Institute for Health and Care Excellence) recommends that any persistent vulval skin change be investigated by a GP to rule out malignancy.

While the exact cause of vulval cancer is not always clear, certain factors may increase your risk. These include:

• Human Papillomavirus (HPV): Certain strains of HPV, the virus that also causes cervical cancer, are linked to vulval cancer.
• Vulval Intraepithelial Neoplasia (VIN): This is a precancerous condition where cells in the vulval skin are abnormal but not yet cancerous.
• Chronic Skin Conditions: Long-term inflammatory conditions like lichen sclerosus or lichen planus.
• Smoking: Research suggests that smoking can weaken the immune system’s ability to clear HPV infections.
• Age: The risk increases as you get older.

Prevention involves attending regular cervical screenings (which can sometimes lead to the discovery of HPV-related vulval changes) and performing regular self-examinations. If you notice a change in the colour, texture, or appearance of your vulval skin, booking an appointment with a GP is essential.

If you are experiencing symptoms such as persistent itching or have noticed a new lump, you might feel hesitant to visit a surgery in person. Speaking to an online doctor in the UK can be an excellent first step. During a video consultation, a GP can discuss your symptoms in a calm, private environment and help determine the urgency of your case.

While an online GP cannot perform a physical biopsy, they can review photographs (if appropriate and secure) and provide a clinical assessment based on your history. If your symptoms meet the NICE referral criteria for suspected cancer, the online GP can provide a referral letter or advise you on how to access a face-to-face 'two-week wait' urgent referral through your local NHS pathway. Early consultation is key to ensuring that if treatment is needed, it begins as soon as possible.

If a GP suspects that your symptoms require further investigation, you will usually be referred to a gynaecologist. The diagnostic process typically involves:

• Physical Examination: A detailed look at the vulval area under bright light.
• Vulvoscopy: Using a specialised magnifying lens to look at the skin more closely.
• Biopsy: A small sample of skin is taken under local anaesthetic and sent to a lab for testing. This is the only way to confirm a diagnosis of cancer.

If cancer is confirmed, the treatment plan will depend on the stage. Options often include surgery to remove the affected tissue, radiotherapy, or chemotherapy. The multidisciplinary team (MDT) within the NHS works to ensure the most effective treatment while preserving as much healthy tissue and function as possible.

Dealing with concerns about your intimate health can be emotionally taxing. It is common to feel embarrassed or anxious, but healthcare professionals are trained to deal with these topics with sensitivity and discretion. In the UK, there are numerous support groups and resources available for women experiencing vulval conditions, ranging from chronic skin issues to cancer recovery.

Maintaining good vulval hygiene—such as using plain water or unperfumed emollient washes and wearing cotton underwear—can help manage some symptoms of irritation, but these measures should not replace a medical consultation if you have noticed a lasting change.