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Vin-vulval intraepithelial noeplasia

What is vin?

VIN is a skin condition that affects the vulva. If the skin is examined under a microscope, the cells that make up the outermost layer are abnormal. We realise that these changes can occasionally turn in to cancer and so we regard them as pre-cancerous. VIN is graded I-III with III being most severe. Most women we see in this clinic with VIN have VINIII. This leaflet is mainly directed to those women. Lesser degrees of VIN usually disappear with time

What causes vin?

There is no single factor that causes VIN. There appears to be two groups of the disease. One group is linked with a viral infection (the human papillomavirus –HPV) and the other is not. The VIN that is caused by HPV tends to occur in younger women. These women may also have had problems with cervical smear tests in the past. VIN is more common in women whose natural defences are affected as the virus is less likely to be cleared.

What are the symptoms of vin?

Some women may have no symptoms at all. The abnormal area of skin may only be detected at a medical examination (such as when you have a smear check). Many women complain of vulval itching and soreness. Some women notice roughened areas of skin, or a change of colour of the skin. You may also have noticed that sexual intercourse is uncomfortable. Occasionally women may find a lump on the vulva and may experience bleeding from it. It may be that you have suffered from these symptoms for some time before coming to this clinic.

What are the risks to me from having vin?

We regard VIN as a pre-cancerous condition. You may have heard of the term used for women who have abnormal smears. However the risk of skin changes turning cancerous is very small (and much smaller than the risk of having pre-cancerous changes on the cervix). The risk is about 5-10%. This is why we keep you under follow-up and perform regular examinations of the area.

What are the options for treatment?

If the changes are very minor and not causing trouble, they may disappear by themselves over time. This is especially so if the diagnosis has been made while you are pregnant. In this situation we will usually keep you under observation, by bringing you back to clinic, and simply wait until the changes disappear. If the skin changes are more severe, and especially if they are causing you trouble, we will treat them by surgery. We remove the affected area of skin, usually under a general anaesthetic (with you asleep) and this can often be carried out as a daycase. You will have dissolvable stitches, which should disappear within a couple of weeks. Other treatments include destroying the affected skin with a laser. There are some new treatments under investigation, which are designed to improve the body’s natural defences. We can provide you with information on these therapies and our current research projects.

What follow up is needed?

Whatever approach we take to treatment in your case, we will need to keep you under observation with visits to clinic every few months. As your symptoms become controlled, the visits will become less often and provided the skin looks normal. We will also make sure that you are up to date with cervical smear checks.

Support groups and other resources

The vulval pain society (VPS) provides women with information on vulvodynia and other vulval disorders.
Vulval Pain Society
POBox 514


http://www.oncoliunk.upenn.edu this is a huge and well laid out site covering all aspects of cancer although it is not very detailed on pre-invasive disease

medweb http://medweb.bham.ac.uk/divisions/reprochildhealth/obgyn/preinvasivedisease.htm

this page is an overview of all pre-invasive gynaecological conditions

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