The Vulvar Intra-Epithelial Neoplasia (VIN) Clinic
For women who have been previously diagnosed and treated for Vulvar Intra-Epithelial Neoplasia (VIN).
What is VIN?
Vulvar intraepithelial neoplasia (VIN) is a pre-cancer condition of the vulva that can progress to cancer if left untreated. While the risk of VIN becoming a cancer is small in the short term (less than 5%), if the lesion is left untreated for years this risk increases over time. VIN is becoming more common, with its incidence in the United States increasing more than fourfold from 1973 to 2000, to 2.86 per 100 000 women.
New patients will be initially assessed in the Vulvar Oncology Clinic and then followed in the VIN Follow up clinic.
What causes VIN?
There are two types of VIN. One type is called “Usual type VIN” and it is caused by a virus – the human papillomavirus (HPV) virus. This virus is spread by direct intimate skin-to-skin contact (generally during sexual intercourse). If you have usual type VIN, it is because you were exposed at some point in time to HPV. Most healthy adults are exposed to HPV during their life; some adults become infected and carry the virus in their skin. VIN may develop years after the initial infection. VIN is often classified as VIN 1, VIN 2 and VIN 3. Only VIN 2 & 3 are pre-cancerous conditions that need to be treated.
The other type of VIN is called “Differentiated VIN”. This may develop in women who have a chronic skin condition that causes inflammation of the skin of the vulva – like Lichen Sclerosus or Lichen Planus. The vast majority of women (greater than 95%) with these skin conditions do not develop VIN.
What are the symptoms?
Many women have symptoms such as itch, irritation, pain, or discomfort relating to VIN and/or its treatment. Women may experience daily symptoms. This may affect their clothing choices, social activities, work, or sleep. Women may experience feelings of anxiety, depression and embarrassment around the diagnosis. Women may also feel concerned about the appearance of the vulva. Some women do not have any symptoms but rather notice a bump and or change to the skin. The vulvar skin that is abnormal (VIN) may be red, white and or pigmented. The area may be a bump or rough patch. Some lesions may resemble “warts”. Sometimes VIN presents as a raw area or sore that does not heal. The lesion may be on the vulva and or around the anus. Any skin change that does not heal within a month should be evaluated by a health care provider.
How is it diagnosed?
On clinical examination the abnormal areas of skin are identified and then a skin biopsy is done. VIN has a distinct appearance under the microscope. A pathologist will look at the skin under a microscope and make the diagnosis.
How is it treated?
The abnormal skin is destroyed or removed. VIN is often treated with surgery (excision, or laser ablation). Sometimes topical medical therapy (eg. 5-fluorouracil) is used to destroy the lesion. Clinicians have also tried using a topical cream, imiquoumod, to stimulate the body’s immune system to heal the skin.
What is the success rate of treatment? All of the surgical treatments are very successful ( more than 90%) in clearing the VIN. However, approximately one-third of patients develop a new lesion over time. This is the reason for ongoing surveillance of the skin.
What is the recommended follow up?
In our clinic, we recommend that women with newly diagnosed and treated VIN see their health care provider every 6 months for 2 years after treatment. After that we recommend that women see their health care provider for an annual vulvar skin exam. All women should participate in a cervical screening program. Women older than 50 should also participate in an anal screening program (eg. digital anal rectal exams).
How to reduce recurrences of VIN?
Smoking suppresses natural immunity and may also make it more likely to develop VIN, and harder to get rid of VIN. So, stopping smoking can help to clear and or reduce your risk of developing a new lesion.
The HPV vaccines protect against infection from certain types of human papillomavirus (HPV) that cause genital warts and cancers of the anus, cervix, mouth and throat, vagina, and vulva. There are 3 vaccines available and they protect against: 2, 4 or 9 different HPV subtypes. The vaccine does not help your body fight an HPV infection that it already has, but it may provide you with protection from the other types of HPV if you have not yet come into contact with them. The HPV4 and HPV9 vaccines are recommended for adult women up to 45 years of age. In BC, the HPV4 vaccine is provided free to girls and young women born in 1994 to 2004 who have not received the vaccine. The HPV9 is provided free to all girls in grade 6.
What is the impact of VIN on the rest of a woman’s health?
The disorder, and or the treatment of that disorder, may have an impact on a woman’s sexual health. Some women report that VIN, and/or its treatment, may cause discomfort during sex, reduced interest in sex, reduced enjoyment of sex, and or anxiety about having sex. Some women will choose not to have sex because of their VIN. This may have a negative impact on her intimate relationship.
Since VIN is a precancerous condition many women worry about their next check-up visit, developing new disease, and having to undergo further testing or treatment. Some women even report concerns about the ability to become pregnant and the possibility of problems with childbirth. Many women with VIN will benefit from seeing other health care providers in the Centre to address their overall health concerns related to their vulvar condition.