Vulval intraepithelial neoplasia (VIN)

How common is it?

This remains unknown. However, most women are seen by a gynaecologist with a special interest in the condition and as a result many women are 'centred' around one or two doctors in a region. It is generally felt that more and more women are being diagnosed with VIN. This is either because the disease is more common or because more women are being accurately diagnosed.

How is it treated?

There is not one type of treatment to suit all women with VIN and the treatment offered to you should be tailored to suit your needs. You will obviously have to discuss this with your doctor. The type of treatment will depend on several factors including one or more of the following:

  • Whether your symptoms are bad
  • Where the affected area is on the vulva
  • How large the affected area is
  • How fit you are for treatment

It is important to remember that not all doctors practise the different treatments mentioned below and different doctors have different experiences of the condition.

Treatments

Take a 'wait and see' approach

Many women with VIN do not have any treatment at all and are simply kept under review at the clinic on a six-monthly or annual basis. This treatment is often practised for women with large areas of VIN and in women who have no symptoms. If you are pregnant this may be an option.

Surgery

Removal of the area has advantages and disadvantages. Removing the area under anaesthetic will hopefully cure localised areas that cause symptoms. Also it may be necessary to remove some of the vulval skin so that it can be examined under the microscope to exclude cancer development. The disadvantages relate to having the surgery and recovery from the skin removal. For very large areas that need removal there can be distortion of the vulval anatomy and shape, but many areas of VIN that are removed heal without any serious scarring. Ask the surgeon if you have any concerns.

Laser treatment

Under general anaesthetic some doctors use the laser to remove the areas of VIN. The advantage of using the laser is that it destroys the very superficial skin layer (epidermis and upper dermis) without scarring or loss of anatomy of the vulva. Its disadvantages relate to recovery post-operatively where good pain relief is initially needed. Sometimes with very large areas, the procedure is done in two stages.

The great difficulty with managing VIN is that following treatment, VIN can recur. As consequence many women will be put on long term, sometimes lifetime, follow-up with a doctor. This procedure is largely abandoned now as the recurrence rates after treatment are high.

Imiquimod treatment

Imiquimod cream uses the immune system to attack the areas of VIN. This means it uses the body's natural defences to kill the pre-cancer cells in the skin. It does this by releasing a number of chemicals called cytokines. The main advantage of Imiquimod cream is that it will not cause scarring so has the advantage of better cosmetic results and you can put it on yourself at home. The disadvantages are that nearly all patients notice a burning sensation when applying the cream which occaisionally can interupt treatment and the response rate of the VIN to treatment is around 60%.

VIN and vulval cancer

Vulval cancer is an uncommon cancer, with only around 1,000 cases diagnosed in the UK each year. Although VIN is regarded as a precancerous condition, up to 20 per cent of women diagnosed initially with VIN will also have an underlying cancer. If VIN is untreated the risk of vulval cancer developing is believed to be very high. With treatment, however, the subsequent risks of VIN patients developing cancer are around 3 to 5 per cent, so close follow-up is important.

What can I do?

Keep follow-up appointments with doctors. Although these visits can generate a lot of anxiety, regular follow-up will hopefully ensure that the VIN remains under control.

If you do have symptoms, then discuss the creams that you can apply with your doctor. Avoid inappropriate antifungals and practise good hygiene.

Smoking has been referred to as a risk factor for VIN. Stopping smoking may make a difference.

Support

The Vulval Health Awareness Campaign/National Vulva Helpline runs a support group for VIN. You can telephone the National Vulva Helpline on 07765 947599.

Further information

A brief discussion of VIN can be found elsewhere on the VPS website inĀ VPS Webinar 2, 1 May 2013: Vulval Pain: Present knowledge - Prof Wendy Reid. If you're watching the video presentation, VIN is covered on slides 16 and 17, or at around the 9 mins 30 secs mark if you're listening to the MP3 soundtrack.