What is Vulvar Intraepithelial Neoplasia?
Vulvar intraepithelial neoplasia (or 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 is not cancer, and not all cases become problematic. In fact, many cases resolve without any treatment. However, if the condition is ignored, it can become cancerous after several years.
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
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
Types of VIN
There are two main types of VIN:
This is the most common type of Vulvar Intraepithelial Neoplasia. It typically is found in women ages 35-60 and is strongly linked to HPV (human papillomavirus). HPV 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’s possible to carry the virus for many years without any outward symptoms.
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 abnormalities, such as lichen planus or lichen sclerosis.
Diagnosing Vulvar Intraepithelial Neoplasia (VIN)
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 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.
Your doctor will recommend a treatment plan based on the severity of your condition. The severity depends on the result of the biopsy, risk for cancer, and the size of the area that is 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:
Surgery is the most frequently recommended treatment for women with VIN. The affected area will be 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 your body.
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 difficult to surgically remove, 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 make sure you fully understand the risks and possible outcomes of treatment.
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 OB-GYN will evaluate your risk and help you understand how you can reduce your risk and monitor your condition. If you notice any changes or if your symptoms return, please call your doctor.