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Vulvar conditions and vulvar cancer foundations

Gynaecological oncology

Itch, pain and lesions that are looked at, named and, when persistent, biopsied.

Foundations

Differentiated VIN, the lichen sclerosus-associated precursor of vulvar squamous carcinoma.
Sagittal fat-suppressed T2 MRI of the pelvis with a bright round cyst at the posterior introitus, a Bartholin gland cyst
  • Lichen sclerosus: pale, atrophic, wrinkled skin in a figure-of-eight around the vulva and anus, with fissures and loss of architecture; itch. Potent topical steroids, long-term follow-up because of a small risk of squamous cancer.
  • Vulvodynia: pain without a visible cause, provoked or unprovoked; managed with pelvic physiotherapy, topical and neuromodulating treatments and psychological support.
  • Vulvar intraepithelial neoplasia: HPV-related (younger, multifocal) and differentiated (older, on lichen sclerosus, higher cancer risk). Biopsy any persistent, pigmented, ulcerated or raised lesion.
  • Vulvar cancer: mostly squamous, in older women, presenting as a lump, ulcer or persistent itch; wide local excision with groin node assessment (sentinel node for small tumours); radiotherapy for advanced disease.
  • Bartholin's cyst and abscess: a swelling at the posterior introitus; incision and drainage with marsupialisation or a Word catheter for an abscess; biopsy a new Bartholin's mass over 40.

On the modelVagina

Frameworks and sources

  • Cunningham et al.: Williams Obstetrics, 26th edition (maternal physiology, labour mechanics, placental anatomy) (2022).

Content reviewed 2026-09. Teaching material for students, not clinical decision support; check the current edition of the guideline your unit uses.