What is vulvar intraepithelial neoplasia?
Vulvar intraepithelial neoplasia (VIN) is a condition in which the skin cells of the vulva develop precancerous cells. The vulva is the external area of a woman’s genitals, including the clitoris, the labia majora, and the labia minora. It forms the opening to the vagina and urethra.
VIN (also called vulvar dysplasia) is not cancer, and not all cases become problematic, and many cases are resolved without any treatment. But there is a chance that these abnormal changes may become vulvar cancer.
What are the symptoms of VIN?
Not all women with VIN experience symptoms. However, some common signs include:
- Itching, burning, or tingling in the genitals.
- Burning during urination
- Vulvar pain
- Painful intercourse
- Warty or raised texture on the vulvar skin
- Red, white, or discoloration of the vulvar skin
What are the risk factors for VIN?
VIN can occur in women of all ages, but it typically only affects women over age 20. VIN is much more commonly found in women over age 35. Common risk factors are:
- Weakened immune system. Immunodeficiency can be caused by disease, certain medications, or hereditary factors.
- Smoking cigarettes. Smoking has also been shown to weaken the immune system.
- Some bone marrow and blood disorders
What are the types of VIN?
There are two main types of VIN:
Usual-type VIN (uVIN)
This is the most common type of Vulvar Intraepithelial Neoplasia. It is typically found in women ages 35-60 and is strongly linked to HPV (human papillomavirus). HPV infection is an extremely common sexually transmitted virus that is spread through skin-to-skin contact with a person who is infected.
Many people are unaware of their infection status because it is possible to carry the virus for many years without any outward symptoms.
uVIN is also known as high-grade squamous epithelial lesions (HSIL), VIN 2, and VIN 3. Infections with high-risk types of HPV usually cause it.
Differentiated VIN (dVIN)
This type is uncommon, but most cases occur in women ages 60-85. Differentiated VIN is not associated with HPV, but it often occurs alongside other vulvar skin conditions, such as lichen planus, lichen sclerosis or lichen sclerosus.
You may have abnormal cells on your vulva known as low-grade squamous epithelial lesions (LSIL), which are typically linked to low-risk types of HPV, the same strains associated with genital warts. These cells rarely develop into cancer and often resolve on their own without needing treatment.
LSIL may also be called VIN 1.
How is vulvar intraepithelial neoplasia diagnosed?
If you’re experiencing any changes or symptoms in your vulva, please make an appointment with your gynecologist. Your gynecologist will conduct a pelvic exam and may perform a colposcopy where they examine your vulvar skin under a colposcope, which is a special magnification lens.
Your OB-GYN may also take a biopsy of your vulvar cells. This process may be uncomfortable. However, a local anesthetic is usually injected into the area before the procedure. Your doctor will then send the specimen to pathology to test the cells for any abnormalities.
What are the treatment options for VIN?
Your doctor will recommend a treatment plan based on the severity of your condition. The severity depends on the biopsy result, the risk for cancer, and the size of the area affected by the cell changes.
If the cell changes are mild, your doctor may want to monitor it with exams. In many cases, the abnormalities will resolve without medical intervention. Your doctor will want to schedule regular exams to track the condition’s progress.
Women at higher risk for cancer (for example, women with a weakened immune system or smokers) will probably require treatment to prevent cancerous changes. If you do smoke, you may be able to boost your immune system to fight the abnormal cell changes by quitting.
Vulvar intraepithelial neoplasia can be effectively treated with:
Topical therapy
Imiquimod is an immune response modifier that stimulates the body’s immune system to attack and eliminate abnormal cells. It’s applied directly to the affected area and can help clear the lesions over time. Imiquimod is particularly beneficial for VIN as it helps avoid surgery, which can sometimes lead to scarring or discomfort.
Surgical removal
Surgery is the most frequently recommended treatment for women with VIN. The affected area is removed via a procedure known as surgical excision. The most severe cases may require a complete vulvectomy, but this is rare. In some cases, the vulvar skin can be replaced with a skin graft taken from a different part of the body.
Ablation
Ablation involves the destruction of the affected area using a high-energy laser beam or a pulse of electricity passed through a special instrument known as diathermy. Ablation is usually only performed if the affected skin would be problematic to remove surgically, such as the skin surrounding the clitoris.
Both surgical excision and ablation will have a permanent effect on your vulvar skin. Depending on the area to be treated, this may impact your sex life. Bring your concerns to your gynecologist to ensure you fully understand the risks and possible treatment outcomes.
You should schedule follow-up appointments with your OB-GYN to check in on your recovery. Some cases are more susceptible to relapse than others. Your healthcare provider will evaluate your risk and help you understand how you can reduce your risk and monitor your condition. Please call your doctor if you notice any changes or if your symptoms return.
Why choose Dr. Thais Aliabadi
Dr. Thais Aliabadi and her team accompany women throughout every stage of their reproductive care, including the joyful and the stressful periods.
Our focus is on helping the patient decide what’s best for their lifestyle. For this, we offer a full range of medical procedures—from routine Pap smears to specialized hormonal tests—as well as a listening ear.
In addition to her own expertise, Dr. Aliabadi also teaches residents at Cedars Sinai Medical Center and medical students at the University of Southern California.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The gynecology practice of Dr. Thais Aliabadi in Beverly Hills is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
VIN FAQs
What kind of cancer does vulval intraepithelial neoplasia lead to?
VIN can potentially lead to vulvar cancer, specifically squamous cell carcinoma of the vulva. It is a precancerous condition where abnormal cells develop on the surface of the vulvar skin. If left untreated or undetected, these abnormal cells can progress to invasive vulvar cancer, although not all cases of VIN lead to cancer.
Can VIN be prevented?
VIN cannot be fully prevented; you can reduce the risk by getting the HPV vaccine, practicing safe sex, quitting smoking, and undergoing regular gynecological exams to detect any early changes. The HPV vaccine can protect you from the high-risk strains of HPV that can become cervical cancer (cancer of the cervix).
Sources
4 Preti M, Joura E, Vieira-Baptista P et al. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of vulvovaginal disease (ISSVD) https://pubmed.ncbi.nlm.nih.gov/35728950/
Diagnosis, Therapy, and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015 – PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066425
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.