Vaginal and Vulvar Cancer | Symptoms and Treatment |MedStar Health
A gynecologist talks with a patient during an office visit.

The specialists at MedStar Health are skilled in diagnosing and treating vaginal and vulvar cancers.

Vaginal cancer

Most cancerous vaginal tumors occur when another cancer, such as cervical or endometrial cancer, spreads. This is called secondary vaginal cancer. Primary vaginal cancer, which starts growing in the vagina, is very rare.

Risk factors

Women whose mothers took diethylstilbestrol (DES) during the first three months of pregnancy are at increased risk for developing adenocarcinoma (a type of cancer that begins growing in glandular tissue).


  • Bleeding after sexual intercourse

  • Painless vaginal bleeding and discharge

  • Pain in the pelvis or vagina

Vulvar cancer

The vulva is the outer part of the female genitals. The vulva includes the opening of the vagina, the clitoris, and the labia majora and labia minora, which are the two sets of skin folds protecting the opening of the vagina. Vulvar cancer most often affects the inner edges of the labia majora or the labia minora. Rarely, the cancer can occur on the clitoris or small glands found just inside the opening of the vagina.

Vulvar cancer most often develops from two causes:

  • Human papilloma virus (HPV): HPV-caused cancer tends to strike women who are younger and, oftentimes, smokers.

  • Genetics: DNA tests from vulvar cancers in older women show a mutation of a certain gene. This gene normally prevents cells from becoming cancerous; when it is mutated, it allows for cells to become cancerous. This type of vulvar cancer affects women age 55 and older.

Risk factors

Keep in mind: many women with the following risk factors never develop vulvar cancer, and some women without any risk factors still develop cancer.

  • Age: Risk increases as a woman ages
  • HPV infection is thought to cause up to half of vulvar cancers
  • Smoking
  • Human Immunodeficiency Virus (HIV), the virus that causes acquired immunodeficiency virus (AIDS)
  • Vulvar intraepithelial neoplasia (VIN), a precancerous condition
  • Lichen sclerosus, which causes the vulvar skin to become very thin and itchy
  • Other genital cancers
  • Melanoma or atypical moles: Having these moles on other parts of the body leads to an increased risk of developing one on the vulva


  • Itching that does not go away or get better

  • A burning sensation

  • Painful urination

  • Bleeding and discharge not associated with your normal menstrual period

You may also notice certain abnormal growths on your vagina, such as:

  • A growth that appears as a red, pink, or a white bump (or bumps) with a raw surface; it may also appear white and feel rough

  • An open sore that does not go away after a month

  • Cauliflower-like growths similar to genital warts

  • A dark, pigmented growth

  • A distinct lump on either side of the opening to the vagina

  • Soreness and a red, scaly area

If you notice any pain or abnormality, you should immediately make an appointment with your doctor. However, don't wait until you notice something—make sure you receive regular Pap tests and pelvic examinations.

Diagnosis of vaginal and vulvar cancers

First, your doctor will take your complete medical history and perform a comprehensive physical examination. Your doctor will examine your uterus, ovaries, cervix, and vagina for any abnormalities. They will also take a Pap smear.

In patients with no symptoms, the cancer may be found during a routine pelvic examination and Pap smear. If a Pap smear is abnormal, but the health care provider cannot see problems with the vagina during a pelvic exam, a colposcopy may be done. A colposcopy is a painless procedure in which your doctor uses a lighted microscope to view your cervix.

The only way to be sure the symptoms you are experiencing are caused by vulvar cancer or a non-cancerous condition is to do a biopsy. Your doctor will remove a small piece of the affected tissue and examine it under a microscope.

If your doctor confirms that the mass is cancerous, you will need more tests to find out how far the cancer has spread. A gynecologic oncologist may perform:

  • Cystoscopy: Using a lighted tube to check the inside surface of the bladder

  • Proctoscopy: Visual inspection of the rectum using a lighted tube

  • Pelvic examination using anesthesia: A more thorough exam that can better see how the cancer has spread

  • Chest X-ray

  • Computed tomography (CT) scan

  • Magnetic resonance imaging (MRI)

  • Positron emission tomography (PET)

Treatment options

  • Surgery

  • Chemotherapy

  • Radiation: For treating vulvar cancers, external beam radiation therapy is used. During the treatment, radiation is delivered from outside the body, and may be used along with chemotherapy. If the tumor is cervical cancer that has spread to the vagina, then both radiation and chemotherapy are used

  • Topical therapy: Drugs are applied directly to the cancer site. This is sometimes used to treat vulvar intraepithelial neoplasia (VIN), a precancerous condition, but it is not used to treat invasive vaginal cancer

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