I have Vulvar Cancer, Now What?

Vulvar cancer represents about 0.3% of all new cancer cases in the US per year and is usually diagnosed in post-menopausal women with an age range of around 65-74. Only around 20% of women diagnosed are under the age of 50. Women are more at risk for vulvar cancer if they:

• Are older in age,
• Have a history of human papillomavirus (HPV),
• Smoke or have smoked,
• Have existing inflammatory vulvar conditions (like lichen sclerosus, vaginitis, psoriasis, eczema),
• Have had prior pelvic radiation,
• Are immunodeficient.

Often (in around 60% of cases), vulvar cancer is localized to a single area, rather than spread extensively to other areas of the pelvic region (metastases) and has around an 85% survival rate at 5 years after diagnosis.

Unfortunately, vulvar cancer can be difficult to notice right away, as symptoms may take a while to present. Otherwise, the affected area may feel irritated, painful, or look like eczema, which are symptoms that could be similar to other sexual dysfunctions like vulvar pain (vulvodynia). Later symptoms may include bleeding, pain, abnormal discharge, and urinary or bowel issues. Because of the intimate nature of these symptoms, some women may feel too embarrassed to discuss their troubles with a healthcare provider, leading to a longer period of time without care.

Options for Treatment

After a vulvar cancer diagnosis, the first line of treatment is surgical removal of any cancerous cells, coupled with radiotherapy or chemotherapy, depending on the stage of cancer.

If diagnosed early enough, this surgery could be relatively minor, with cosmetic changes or pain afterward. However, in cases where the cancer has spread further, doctors may need to remove more parts of the vulva and try to save other vital organs like the urinary tract, rectum, clitoris, and uterus.

In the most extreme cases, removal of pelvic organs may be necessary, although this is rare.

Sexual Dysfunction with Vulvar Cancer Treatment

All treatment types may impact sexual functioning. Chemotherapy and pelvic radiation are known to cause urinary issues, vaginal dryness, vaginal atrophy, and sexual pain (dyspareunia). Luckily, these may be able to be treated with hormonal medications, like vaginal estrogen, if cancer care teams give the all-clear.

Surgery, despite efforts to make it more targeted, can still result in the need for reconstruction. Often, vulvar surgery can lead to body image and identity changes, self-esteem issues, and dyspareunia or other vulvodynia.

There is an interesting cycle that occurs between cancer, sexual dysfunction, and mental health. Cancer and sexual dysfunction can both be worsened by depression and anxiety. But depression and anxiety can both be worsened by cancer and sexual dysfunction. It is important to know that this may occur, so a mental health professional can be involved in care plans.

Key Takeaways

• Vulvar cancer is rare, accounting for just 0.3% of all new cancers in the US.
  • Its rarity and primary age range (65-74) may result in later-stage diagnosis and more intensive treatment.
• Treatment may involve surgery to remove cancerous cells, pelvic radiation, and chemotherapy.
  • These often contribute to sexual dysfunction and lower quality of life.
• Vulvar cancer care should include sex and mental health therapy, as well as treatments for menopause-related changes and sexual dysfunction, like vaginal estrogen, DHEA, and testosterone.
• It may be beneficial to schedule a yearly physical with a healthcare provider as a preventative measure.

Resources

Aerts, L., Enzlin, P., Vergote, I., Verhaeghe, J., Poppe, W., & Amant, F. (2012). Sexual, psychological, and relational functioning in women after surgical treatment for vulvar malignancy: A literature review. The Journal of Sexual Medicine, 9(2), 361–371. https://doi.org/10.1111/j.1743-6109.2011.02520.x

Hazewinkel, M. H., Laan, E. T. M., Sprangers, M. A. G., Fons, G., Burger, M. P. M., & Roovers, J.-P. W. R. (2012). Long-term sexual function in survivors of vulvar cancer: A cross-sectional study. Gynecologic Oncology, 126(1), 87–92. https://doi.org/10.1016/j.ygyno.2012.04.015

Malandrone, F., Bevilacqua, F., Merola, M., Gallio, N., Ostacoli, L., Carletto, S., & Benedetto, C. (2021). The impact of vulvar cancer on psychosocial and sexual functioning: A literature review. Cancers, 14(1), 63. https://doi.org/10.3390/cancers14010063

Olesen, M. L., Seibæk, L., & Sekse, R. J. (2023). Impaired sexual health among women treated for vulvar cancer: An integrated review. Journal of Clinical Nursing, 32(17–18), 6212–6228. https://doi.org/10.1111/jocn.16753