Cancer of the vulva is a rare type of cancer with around 1,000 new cases being diagnosed each year in the UK.

The vulva

The vulva is a collective term to refer to the external sex organs of a woman and the skin that surrounds them. The vulva is made up of:

• the opening of the vagina
• two sets of a pair of lips that surround the vagina – the two inner lips are known as the labia minora and the outer lips are known as the labia majora
• the opening of the urethra – the urethra is a tube that runs from the bladder through which a woman passes urine out of her body; the opening of the urethra is located above the opening of the vagina
• the clitoris – which is a sexual organ, around the size of a button, that is located above the urethra; the clitoris helps woman reach sexual climax

In three out of four cases the cancer first develops in one of the patient's labia.

Symptoms

Symptoms of vulval cancer include:

• the development of a noticeable lump, mass or wart-like growth on a section of the vulva
• persistent itchiness in the vulva
• pain when passing urine
• bleeding from the vulva or passing a blood-stained discharge

Read more about the symptoms of vulval cancer.

Types of vulval cancer

The various different types of vulval cancer are classified by the type of cells that the cancer first develops in.

By far the most common is known as squamous cell carcinoma, which accounts for over 90% of all cases of vulval cancer. In this type the cancer develops in cells found on the outer layer of the body.

The second most common type is known as vulval melanoma, which accounts for 4% of all cases. In this type the cancer develops in the cells that give skin its colour.

Other, very rare, types of vulval cancer include:

• adenocarcinoma, which develops from the cells that line the glands in the vulva
• verrucous carcinoma, which is a slow-growing type of vulval cancer that looks like a wart
• sarcoma, which develops in tissue such as muscle or fat under the skin

Who is affected

There are two main groups of women who are affected by vulval cancer.

The largest group are older women over the age of 65 who often have a history of non-cancerous inflammatory skin conditions affecting their vulva, particularly a condition called lichen sclerosus. This group account for around three to four out of five cases.

The second smaller group are younger women who have not yet gone through the menopause, who account for the remaining one to two out of five cases.

The exact cause of vulval cancer is still unclear but significant risk factors include:

• age
• smoking
• persistent infection with specific high-risk strains of the human papilloma virus (HPV), particularly a strain known as HPV 16, which is a strain of HPV virus responsible for a large number of cases of cervical cancer
• vulval intraepithelial neoplasia (VIN) – VIN is a condition where the skin cells around the vulva experienced pre-cancerous changes but "full blown" cancer has not yet developed; a minority of women with VIN will go on to develop vulval cancer

HPV infection and VIN are responsible for the majority of cases in younger women.

Read more about the possible risk factors and causes of vulval cancer.

Treatment

The mainstay of treatment for vulval cancer is surgery. The surgery will remove cancerous tissue from the vulva while trying to minimise the impact of surgery on the vulva. However, in some cases this may not be possible.

A combination of radiotherapy and chemotherapy can also be used as the main treatment if surgery would lead to a loss of bladder control (urinary incontinence) or bowel control (bowel incontinence). This combination can also be used to slow the spread of advanced cancer if a cure is not possible, which is known as palliative care.

Read more about the treatment of vulval cancer.

Emotional impact

Any type of cancer is likely to have a considerable negative emotional impact. But developing a cancer in one of the most intimate parts of the body can be profoundly distressing for some woman.

It can also take several months to adjust to the effects of surgery – both physical and psychological.

There are a range of services that can provide both practical and emotional support for people affected by vulval cancer.

You can read more about recovering from the effects of vulval surgery.

Outlook

The outlook for the squamous cell carcinoma type of vulval cancer is good and many people will recover fully.

Around 70% of people with that type of vulval cancer will survive for at least five years after diagnosis, many will live much longer and most of them will be cured.

As you would expect, squamous cell carcinomas diagnosed in the initial stage have a much higher five-year survival rate (90%) than carcinomas diagnosed in their most advanced stage (13%).

The outlook for the melanoma type of vulval cancer is less favourable. But it is hard to estimate a reliable five-year survival rate as it is such a rare type of cancer.

However, there are other independent factors that could improve (or worsen) your own outlook, so the above figures should only be taken as a general estimate.

The most common initial symptoms of vulval cancer are:

• a persistent itch in the vulva
• the development of a lump, swelling or mass in the vulva; in most cases this will be on or near one of your labia
• raised and thickened patches of skin that can have a red, white or black appearance
• bleeding from your vulva or releasing a blood-stained discharge unrelated to menstruation
• a mole on the vulva that changes shape or colour
• a general sense of pain and discomfort in your vulva

When to seek medical advice

Contact your GP if you happen to experience any of the symptoms listed above.

While it is highly unlikely to be the result of vulval cancer, these types of symptoms require further investigation.

Cancer begins with a change in the structure of DNA. DNA provides our cells with a basic set of instructions, such as when to grow and reproduce.

A change in DNA structure is known as a mutation, and it can alter the instructions that control cell growth. This means that the cells continue to grow instead of stopping when they should. This causes the cells to reproduce in an uncontrollable manner, producing a lump of tissue called a tumour.

How does vulval cancer spread?

There are three ways that vulval cancer can spread.

The first is directly, spreading out of the tissue of the vulva and into surrounding parts of the body such as into the inside of the vagina or urethra.

The second is via the lymphatic system. The lymphatic system is a series of nodes (or glands) and channels that are spread throughout your body, much like your blood circulation system.

One way of thinking about it is as a kind of underground railway where the channels are the train tracks and the lymph nodes the underground stations.

You may sometimes notice swollen nodes in your neck or under your armpit when you have an infection.

The lymph nodes produce many of the specialised cells that are needed by your immune system.

The first group of lymph nodes that can become affected by the cancerous cells are located in your groin.

The final way is via the bloodstream into distant organs such as the lungs, brain, liver and bones.

This generally only occurs in advanced vulval cancer after the cancer cells have spread to multiple lymph nodes.

Cancer that has spread to other parts of the body is known as metastatic cancer.

Known risk factors

Exactly what causes the cells of the vulva to become cancerous is unclear though a number of risk factors have been identified. These are:

• age
• human papilloma virus (HPV)
• vulval intraepithelial neoplasia (VIN)
• skin conditions that can affect the vulva, such as lichen sclerosus (see below)
• smoking

Age

Two out of three cases of vulval cancer develop in women aged 65 or over, with just under half of the cases occurring in older women aged 75 or above.

Age is also a significant risk for a whole range of other cancers, such as lung cancer, prostate cancer and breast cancer. The older you get the more chance there is that certain cells in your body could be damaged, triggering the onset of cancer.

Human papilloma virus (HPV)

Human papilloma virus (HPV) is the name given to a family of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat.

HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer. It is thought that the virus could have a similar effect on the cells of the vulva. One expert has estimated that around 30% of vulval cancer cases are associated with an HPV infection.

The HPV virus is spread during sexual intercourse, including anal and oral sex.

Vulval intra-epithelial neoplasia (VIN)

Vulval intra-epithelial neoplasia is what's known as a pre-cancerous condition.

A pre-cancerous condition is where there are some changes to the biological make-up of certain cells.

The changes are not the same as with new cancers but potentially these changes could lead to the formation of a new cancer at a later date.

Symptoms of VIN are similar to that of vulval cancer and include:

• persistent itchiness in the vulva
• a burning sensation when passing urine
• the development of raised patches of skin that can be red or white in appearance

There are two types of VIN:

• usual VIN or undifferentiated VIN – this usually affects women aged 35 to 55 and is thought to be caused by an HPV infection
• differentiated VIN or dVIN – this is a rarer type, usually affecting older women aged 55 to 85 and is associated with skin conditions that can affect the vulva (see below)

VIN can be treated by removing affected areas of skin or in some cases using a cream called Imiquimod that is designed to help kill abnormal cells. There is also ongoing research seeing whether another type of cream called cidofovir may be an effective treatment for VIN – Cancer Research UK has more information on the current state of research into vulval cancer.

For more information of VIN, visit the British Society for the Study of Vulval Disease (BBSVD) website’s article on VIN.

Skin conditions

There are several skin conditions that can affect the vulva, with two being lichen sclerosus and lichen planus.

Both conditions cause similar symptoms in that they cause affected areas of skin to become very itchy and sore and lead to the development of a red raised rash.

The causes of both conditions are unknown.

It is estimated that around 1 in 50 women who develop one of these conditions will go on to develop vulval cancer.

For more information, see Lichen planus and Lichen sclerosus.

Smoking

Smoking increases your risk of developing vulval cancer as well as a range of other serious diseases such as heart disease, stroke and lung cancer.

One study found that women who smoked were twice as likely to develop vulval cancer than non-smokers.

The chemicals in tobacco smoke are known to cause damage to the cells of the body. Smoking can also weaken your immunity (defence against infection), making you more vulnerable to the harmful effects of a HPV infection.

Before diagnosing vulval cancer, your GP will ask you about your symptoms and look at your medical history to see what illnesses you have had in the past.

Your vulva will be examined to see if there are any lumps or unusual areas of skin.

If you would prefer to be examined by a woman doctor or you would like a nurse present during the examination, let your GP's surgery know in advance of your appointment.

Referral to a gynaecologist

Your GP will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system.

Colposcopy and biopsy

Gynaecologists often use an instrument called a colposcope to look for any abnormalities in the vulva, cervix and vagina.

A colposcope is a small microscope with a light on the end of it. During the examination (colposcopy), a tissue sample will also be taken from the place where the cancer might be, using a special instrument. This is called a biopsy.

You may have additional biopsies where samples of tissue are removed from the lymph nodes near your vulva. This is to check whether cancer has started spreading through your lymphatic system.

Anaesthetic cream is applied to your vulva and an injection of local anaesthetic is given, so the biopsy should not hurt. You may have slight bleeding and soreness afterwards.

The tissue sample is then checked in a laboratory to find out whether you have cancer and what type of cancer it is. Your doctor will usually see you up to ten days later, when the results come through.

Further testing

If the results of the biopsy suggest that you have cancer and there is a risk that the cancer may have spread, you will probably need further testing to assess how widespread the cancer is.

These tests are described below.

• Cystoscopy – an examination of the inside of the bladder. It is done to see if the cancer has spread to the bladder. A thin, hollow viewing tube is inserted into the bladder to look for tumours and take a tissue sample.
• Proctoscopy – an examination of the inside of the rectum. The doctor either uses a gloved finger on an instrument called a proctoscope to check for abnormalities such as growths on the wall of the anus.
• CT scan – a computerised X-ray that can take detailed pictures of the inside of the body. It is useful for showing up cancer tumours and checking whether cancer cells have spread.
• MRI scan – a scan that uses radio waves and magnets to produce detailed pictures of the inside of the body. It is used to check whether cancer has spread.
• X-ray – you may have a chest X-ray to check that cancer has not spread to your lungs.

Staging

Once the results of the tests are complete it should be possible to tell you what stage cancer you have.

Staging is a measurement of how far the cancer has spread. The lower the stage, the greater the chance of a complete cure.

The staging system for vulval cancer is as follows:

Stage 1 – the cancer is confined to the vulva. Stage 1 is further divided into two sub-types:

• Stage 1A – the cancer is less than 2cm in size
• Stage 1B – the cancer is larger than 2cm in size

Stage 2 – the cancer has spread beyond the vulva to other nearby parts of the body such as the lower vagina, anus or lower urethra (the tube you urinate out of), but the lymph nodes are unaffected.

Stage 3 – the cancer has now spread into nearby lymph nodes. Stage 3 is divided into three sub types:

• Stage 3A – the cancer has spread into one lymph node and the area of spread is more than 5mm OR the cancer has spread into one or two lymph nodes but the area of spread is less than 5mm
• Stage 3B – the cancer has spread into two or more lymph nodes and the area of spread is more than 5mm OR the cancer has spread into three or more lymph nodes but the area of spread is less than 5mm
• Stage 3C – the cancer has begun spreading through the outer covering of at least one of the lymph nodes

Stage 4 – the cancer has spread away from the vulva and perineum (the area of skin and tissue between the anus and the genitals) to other parts of the body. Stage 4 is divided into two sub types:

• Stage 4A – the cancer has spread into the upper urethra or into the lining of the vagina, bladder, rectum or the bones of the pelvis OR the cancer has caused lymph nodes to become stuck to underlying tissue or caused open sores (ulcers) to develop in the groin
• Stage 4B – the cancer has spread to more distant parts of the body such as the lungs, liver or the lymph nodes that are contained in the pelvis

Stage 1 and 2 vulval cancers are regarded by most experts as early stage cancers with a relatively good chance of a complete cure.

Stage 3 and 4 vulval cancers are usually regarded as advanced-stage cancers and a cure for this types of cancers may not always be possible.

Biopsy

A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Bladder

The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.

Colposcopy

A colposcopy is a procedure where a doctor uses a special magnifying lens, known as a colposcope, to look at the cervix through the opening of the vagina.

Cystoscopy

A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra.

Lungs

Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

MRI

MRI stands for magnetic resonance imaging. It involves the use of magnets and radio waves to take detailed pictures of inside the body.

Nodules

A nodule is a small growth or lump of tissue.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

Cancer treatment team

Many hospitals use multidisciplinary teams (MDTs) to treat vulval cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.

Members of your MDT will probably include:

• a gynaecological oncology surgeon – a surgeon who specialises in treating cases of cancer that develop inside the female reproductive system
• a clinical oncologist (a specialist in the non-surgical treatment of cancer)
• a pathologist (a specialist in diseased tissue)
• a radiologist (a specialist in radiotherapy)
• a social worker
• a psychologist
• a specialist cancer nurse, who will usually be your first point of contact with the rest of the team

Your treatment plan

Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Surgery

In most cases your treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer.

To treat vulval cancer there are two surgical options:

• radical wide local excision – where the cancerous tissue from your vulva is removed as a well as a margin of healthy tissue, usually around 1cm, as a precaution
• radical vulvectomy – this involves removing a larger section of your vulva, such as one or both of the labia and the clitoris

The preferred surgical option will depend on the site and size of the cancer.

If the cancerous cells have spread into one or more lymph nodes in your groin, these will need to be assessed by an additional surgical procedure. 

In some circumstances this can be done by a process to remove the lymph nodes most likely to be affected by cancer. These lymph nodes are known as sentinel nodes.

The nodes are identified by injecting a dye at the site of the tumour and then studying the flow of dye in order to locate the nodes closest to the tumour, which would be the sentinel nodes. These nodes are then removed and checked for the presence of cancerous cells.

Depending on the results of the biopsy, some or all of the nodes in your groin and upper legs will need to be surgically removed. This type of operation is known as a lymphadenectomy. 

Larger tumours and cases where the lymph nodes appear enlarged are not suitable for sentinel node biopsy, and the removal of all the lymph nodes in your groin is likely to be recommended. This is called an inguino-femoral lymphadenectomy. 

If lymph nodes are affected by cancer, further treatment with radiotherapy is likely to be advised.

Performing a lymphadenectomy does reduce the risk of the cancer returning but it can make you more vulnerable to infection and cause swelling in your legs due to a build-up of lymphatic fluid. This type of swelling is known as lymphoedema. Read more about the complications of surgery for vulval cancer.

In cases of advanced vulval cancer or if the cancer returns after previous treatment, an operation called a pelvic exenteration may be recommended. This involves removing your entire vulva as well as your bladder, womb and part of your bowel.

If a section of your bowel is removed it will be necessary to create holes in your abdomen, known as stoma, in order that the bowel can be passed out into collection pouches that you wear next to your body.

A collection pouch for receiving bowel content is called a colostomy.

And if your bladder is removed there are a number of options open to you. As with a colostomy, your urine can be passed out of your body into a pouch via a stoma. Or it may be possible to create a "new bladder" by removing a section of your bowel and using it to create a pouch to store urine in.

The section on complications on bladder cancer has more detailed information on the treatment options available to people who have had their bladder surgically removed.

The time it will take you to recover from surgery will depend on the type of surgery and how extensive it was. For very extensive operations such as a pelvic exenteration it may take up to eight weeks to recover.

Read more about recovering from the effects of surgery.

Reconstruction

If only a small amount of tissue has been removed, the skin of the vulva will be neatly stitched together. Otherwise, it may be necessary to have a skin graft where a piece of skin is taken from your thigh or abdomen to cover any wound in your vulva. Another option is to have a tissue flap where a sample of skin, tissue and fat is taken from another part of your body, usually the back or the abdomen, and used to help reconstruct the vulva.

Radiotherapy

Radiotherapy involves using high-energy radiation, usually X-rays, to destroy cancerous cells.

Radiotherapy can be delivered as:

• internal radiotherapy – where a radioactive implant is placed directly into cancerous tissue
• external radiotherapy – where a machine outside of the body beams the radioactive ways onto the section of the body that contains the cancer

There are two main ways that radiotherapy can be used in the treatment of vulval cancer:

• It can be given after surgery in order to destroy any cancerous cells that may be left, for example for cases where cancer cells  have spread to the lymph nodes in the groins.
• It can be given to relieve symptoms in cases where a complete cure is not possible – this is known as palliative radiotherapy

Radiotherapy can also be combined with chemotherapy as an alternative to surgery if it was likely that surgery would cause extensive damage to your bladder or bowel and you were unwilling to have a stoma or new bladder.

There are different ways that internal radiotherapy for vulval cancer can be given and they can vary from specialist centre to specialist centre. If internal radiotherapy is recommended for you, your MDT will be able to provide more information on what will be involved.

External radiotherapy is normally given in daily sessions, five days a week, with each session lasting around 10-15 minutes. Most people require four to five weeks of sessions.

While the radiation is effective in killing cancerous cells, it can also damage healthy tissues leading to a number of side effects, such as:

• sore skin around the vulva area
• diarrhoea 
• feeling tired all the time
• loss of pubic hair
• swelling of the vulva
• narrowing of your vagina, which can make sex difficult
• inflammation of your bladder (cystitis), which in turn can cause you to have a frequent need to urinate

In younger women external radiotherapy can sometimes trigger an early menopause. This means they will no longer be able to have any children.

Read more about radiotherapy.

Chemotherapy

Chemotherapy is usually used in combination with radiotherapy or to control symptoms when a cure is not possible or as an alternative to surgery that would require a colostomy or ileal conduit urinary diversion (where urine is passed out of the body in a method that does not involve the bladder, such as through a stoma or an internal pouch).

Chemotherapy is the use of anti-cancer medication to destroy cancer cells. It is usually given by injection.

The medicines used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Unfortunately, side effects are common and include:

• feeling sick
• being sick
• hair loss
• sore mouth
• mouth ulcers 
• tiredness

These side effects should stop once the treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

So it is important to report any symptoms of a potential infection, such as a high temperature, persistent cough or reddening of the skin to your MDT. You should also avoid close contact with people known to have an infection.

Read more about chemotherapy. 

Lymph nodes

Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.

Radiotherapy

Radiation therapy uses X-rays to treat disease, especially cancer.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat. 

The first few days

When you wake up after surgery it is likely that you will have a drip in your arm to provide you with fluids.

Usually a thin tube known as a catheter in inserted into your bladder in order to drain urine out of it.

The catheter drip can usually be removed after a few days.

You may also have a tube in your groin to drain away excess fluid that would have gathered if your have had your lymph nodes removed. This can usually be removed after a week.

The site of the surgery will usually be sealed with disposable stitches that should disappear once the wound heals. The wound will need to be washed frequently with fluid in order to prevent it becoming infected.

It is likely that you will be in some pain for the first few days after the operation so you will be given painkilling medication, which can be given as a injection, in tablet form or pumped directly into your spine. This is known as an epidural.

You will be encouraged to perform some gentle exercise as soon as possible after the surgery as this can help prevent problems such as blood clots in your legs (deep vein thrombosis).

A nurse or physiotherapist will show you what types of exercises are suitable for you.

Your vulva

You may experience numbness and changes in sensation around your vulva which are caused by the surgery. These feelings should pass within a few months.

Depending on the type of surgery you had, the appearance of your vulva may have changed quite a bit.

Some women are not particularly bothered by this. Other women can find these changes in appearance deeply upsetting.

If you are concerned about viewing your vulva for the first time you may want to do it in the company of a nurse who will be able to explain how your vulva has been changed.

Or some women prefer to look by themselves, or in the company of a relative, friend or loved one.

Going home

Depending on the type of surgery that you have it may take anywhere from a few days to a few  weeks before you are well enough to leave hospital.

You may be told not to lift any heavy objects after your surgery as this could damage your wound. Your surgical team will be able to provide a more precise recommendation.

For the same reason you may be told to avoid driving for four to six weeks after your surgery. And it may take several months before you are well enough to return to work.

Your MDT will be able to provide you with individual recommendations.

Sex

It is normally safe to have sex around six to eight weeks after surgery, but many women do not feel ready for sex even after this length of time.

Both the stress of living with vulva cancer and the impact of surgery can have a obvious impact on your feelings about sex that may take some time to comes to terms with.

Macmillan cancer support have excellent articles on how surgery for vulval cancer can affect your sex life and sexuality and cancer.

Lymphoedema

If you have lymph nodes in your groin removed this can sometimes disrupt your lymphatic system.

One of the functions of the lymphatic system is to drain away excess fluid from the tissue of your body, so this disruption can lead to a build-up of fluid in the tissue. 

This in turn can cause swelling of certain body parts; usually the arms and legs. This condition is known as lymphoedema.

There are exercises and massage techniques you can be taught that can help reduce the swelling. Wearing specially designed bandages and compression garments can also help.

Read more about the treatment of lymphoedema.

Emotional impact

The emotional impact of living with vulval cancer can be significant. Many people report experiencing a kind of roller-coaster effect.

For example, you may feel very down at receiving a diagnosis, feel very up when you get confirmation that the cancer has been removed from your body and then feel very down again as you try to come to terms with the after-effects of surgery.

This type of emotional disruption can sometimes trigger feelings of depression. Signs that you may be depressed include:

• During the past month you have been bothered by feeling down or hopeless.
• You no longer take pleasure in things you enjoy.

If you think you may be depressed, contact your GP for advice. There are a range of relatively successful treatment for depression such as antidepressant medication and talking therapies such as cognitive behavioural therapy.

Read more about depression and coping with cancer.

Due to its rarity there are no dedicated charities and support groups for women with vulval cancer but you may find it useful to contact one of the main cancer charities such as:

• Macmillan Cancer Support – who have a helpline on 0808 808 00 00 (Monday to Friday, 9am to 8pm)
• Cancer Research UK – who have a cancer nurse helpline on 0808 800 4040 (Monday to Friday, 9am to 5pm)

Practising safe sex

There is a strong link between certain types of human papilloma virus (HPV) and the development of abnormalities that may turn into vulval cancer.

As HPV is spread through unprotected sex, using a condom is the best way to avoid it. However, a condom can only provide limited protection against HPV so it is still important to attend your cervical screening tests (see below) even if you do practise safe sex.

Before beginning a sexual relationship with a new partner, it is a good idea for you both to be tested for sexually transmitted infections at a sexual health (GUM) clinic. All tests are free and conducted in confidence.

Read more about safe sex and sexual health.

Cervical screening tests

Regular cervical screening tests are also important in detecting sexually transmitted infections and pre-cancerous conditions such as vulval intra-epithelial neoplasia.

Read more about on cervical screening tests.

HPV vaccination

There is now a vaccine that provides protection against the strains of HPV that are thought to be responsible for most cases of vulval cancer. HPV vaccination also protects against cervical cancer, which is far more common than vulval cancer.

Girls should be offered the HPV vaccine as part of their routine childhood immunisation programme. The vaccine should be given to girls who are 12 to 13 years old, with three doses given over six months.

Read more about HPV vaccination.

Quit smoking

You can decrease your chance of getting vulval cancer by not smoking. Smokers are less able to get rid of the HPV infection from the body, which can develop into cancer.

Read more about quitting smoking.