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Vulvar Dysplasia

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Introduction

Vulvar Dysplasia is also known as vulvar intraepithelial neoplasia (VIN). As the name suggests, it is the condition in which there are abnormal changes in the skin of the vulva.

Vulvar Dysplasia is a precancerous lesion of the vulva; the outer covering in the female genitalia. It is not cancer, however, is indicative of vulvar cancer.

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What are the Types of Vulvar Dysplasia?

Based on the severity, vulvar intraepithelial neoplasia can be of three types as follows:

  • ● Low-grade Squamous Intraepithelial Lesion (LSIL)
  • ● High-grade Squamous Intraepithelial Lesion (HSIL)
  • ● Differentiated VIN (DVIN)

These are identifiable following a detailed microscopic examination. Sometimes, based on the depth of the lesion, it is also classified as VIN1, VIN2, VIN3, etc.

What are the Causes of Vulvar Dysplasia?

The exact causes of Vulvar Dysplasia are still not known. It is however observed that individuals with the following history tend to develop this disease:

  • ● Infection with Human papillomavirus (HPV)
  • ● History of smoking or current smoker
  • ● Infection with Herpes simplex virus
  • ● Chronic vulvar irritation
  • ● Infection with granuloma inguinale which is a sexually transmitted disease (STD)
  • ● Immunosuppression due to drugs or other diseases

What are the symptoms of Vulvar Dysplasia?

The symptoms of the disease may vary and usually manifests as the following:

  • ● Burning, tingling, or soreness of the vulva or nearby areas
  • ● Chronic itching in the vulvar region
  • ● Change in the appearance of the affected area. You may also notice areas of redness or white, discolored skin
  • ● Pain during sexual intercourse
  • ● Visibly raised skin lesions; some may appear darkened like a mole or freckle

In some rare cases, there are no initial symptoms.

How is Vulvar Dysplasia Diagnosed?

To diagnose Vulvar Dysplasia, the  doctor examines you thoroughly.A colposcopy is then followed by to determine the extent of the lesion physically. It is an office procedure that uses a special microscope known as a colposcope to closely examine the tissue for abnormal areas.

Your doctor might recommend a biopsy of the affected area if a detailed investigation is needed. It is generally done to get the exact diagnosis by visualizing the tissues under the microscope. A local anaesthetic is given to numb the area, and a small sample of vulva tissue is taken. This sample is sent to the pathology lab for microscopic examination.

How is Vulvar Dysplasia Prevented?

You can surely prevent the disease from occurring with some careful lifestyle changes. Practice safe sex, use protection, and try to avoid changing sexual partners frequently. Consider HPV vaccination for girls in your family before their first sexual intercourse. Regular physical examination for early detection and treatment is recommended to prevent Vulvar Dysplasia from transforming into vulvar cancer.

How is Vulvar Dysplasia Treated?

Treatment of Vulvar Dysplasia may vary depending on the abnormality of the skin cells, the size of the lesion, and the probability of it developing into vulvar cancer. Your doctor will be the best judge to start any  treatment. It is recommended that if you suspect any changes or an initial symptom matching Vulvar Dysplasia, consult your doctor rather than starting any treatment on your own. Sometimes, your doctor may need to collate with other expert doctors in this field so that the whole team of doctors could make a better judgment call.

Based on the judgment your doctor makes, the following treatment options may be open for you:

  • ● Your doctor may recommend certain steroid creams to reduce inflammation and control the symptoms of the affected area. This will also require close monitoring for improvement or deterioration of the local lesion.
  • ● Topical chemotherapy creams to remove abnormal cells are usually prescribed for regular use.
  • ● If needed, your doctor may recommend a surgery to remove the abnormal tissues. This is different from just a biopsy, as it is a complete excision of the lesion. It is usually considered as a surgical intervention with the intention of treatment rather than diagnosis. Usually, it is performed after the extent, borders and the exact histological diagnosis has been confirmed.
  • ● Laser therapy is a type of targeted beam therapy to destroy targeted areas of abnormal cells in the lesion, using a high-frequency beam of light.
  • ● Diathermy is a procedure performed to cut out a part of or the complete lesion using a tiny electrical current.
  • ● Surgical procedures as extensive as a vulvectomy may be recommended in severe conditions to prevent the condition from transforming into vulvar cancer. Vulvectomy is the surgical removal of the complete vulva. It is done in rare cases where the affected areas are very large.

Vulvar Dysplasia is a recurrent condition. It has been seen that it manifests again, even after completion of the treatment. Therefore, a regular follow-up is highly recommended even after the treatment has been completed. Your doctor will tell you the frequency of follow-up visits needed as per the severity of your condition.

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FAQ's

Do All Vulvar Dysplasia Turn Into Cancer?

No, not all Vulvar Dysplasia or vulvar intraepithelial neoplasia (VIN) turn into vulvar cancer. However, it is recommended to identify it early and treat it as soon as possible.

When Do I Have a Greater Risk of the Vulvar Intraepithelial Neoplasia (VIN) Developing Into Cancer?

Suppose you have a history of genital warts or HPV infection or are currently infected with HPV. In that case, you are at greater risk of Vulvar Dysplasia to develop into vulvar cancer.

Can Vulvar Dysplasia be Cured?

Yes, it can be cured and the key is to arrest its progression. It has been noted that on early diagnosis of the lesion, and confirmation with biopsy if needed, treatment has a better outcome. About 90% of the individuals with early detection of the disease were completely cured.

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