Vulvar and vaginal cancer awareness

Unlike cervical cancer, there are no screening tests for vaginal or vulvar cancers in people who do not have any signs or symptoms. The pap test does not screen for vaginal or vulvar cancers. Therefore, early detection relies on recognising possible symptoms and changes affecting the genital areas, such as persistent itching, pain, sores or ulcers, lumps, skin changes, abnormal bleeding, discharge, or pain during sexual intercourse.

If symptoms or suspicious lesions are present, your healthcare provider may recommend further assessment, which may include a physical examination, colposcopy and/or a biopsy, depending on the clinical situation.

Certain infections and conditions that affect the immune system can increase the risk of vulvar or vaginal cancer.

One of the main risk factors is persistent infection with certain high-risk types of human papillomavirus (HPV), a very common virus that can be transmitted through sexual contact. 

HPV is so common that more than 80% of sexually active people will acquire an HPV infection at some point in their lives. It can be passed between partners regardless of gender and sexual orientation, including through vaginal, anal, or oral sex, genital skin-to-skin contact, or by sharing sex toys. 

In most people, the infection clears on its own. In a small proportion of people, the infection persists and can contribute to the development of vulvar or vaginal cancer over many years. People with a weakened immune system, including people living with HIV or those receiving long-term immunosuppressive treatment, are less likely to clear HPV infections naturally. As a result, they have a higher risk of persistent HPV infection and HPV-related cancers, including vulvar or vaginal cancer.

The good news is that many HPV-related cancers can be prevented through HPV vaccination.

Important to know:

• Condoms reduce the risk of HPV transmission but do not provide complete protection. This is because HPV is transmitted through intimate skin-to-skin contact, including areas that are not covered by a condom. 
• The HPV vaccine protects against many HPV types that can cause vulvar or vaginal cancer. However, the vaccination does not cover all HPV types. For this reason, it is important to seek medical advice if you notice any unusual symptoms, even if you have been vaccinated.

HPV vaccination protects against the high-risk HPV types responsible for most cervical cancers and many cancers of the anus, vulva, vagina, penis, and oropharynx (back of the throat, including the base of the tongue and tonsils). It also protects against the low-risk HPV types that cause most genital warts.

Vaccination is recommended from the age of 9 and is most effective before exposure to HPV, although it can still provide benefits later in life. In Belgium, people who were not vaccinated earlier can still receive the vaccine up to age 30. 

For more information on HPV vaccination, see the dedicated section.

Some types of gender-affirming surgery involve the construction of a neovulva and/or neovagina.

Although very rare, the newly created genital tissues may develop cancers of the skin or mucosal lining. The type of cancer depends on the tissues used during surgery, and some are associated with persistent HPV infection.

As with vulvar and vaginal cancer in people born with these organs, there are no established screening tests. Early detection relies on recognising suspicious changes or symptoms and seeking medical advice promptly if these occur.

Some types of gender-affirming surgery involve the construction of a neopenis and/or neoscrotum. These procedures vary and do not always include removal of the vagina, cervix, uterus, ovaries or other organs. The risk of cancer therefore depends on which organs and tissues remain after surgery. Please refer to the relevant sections of this guide for information on prevention and early detection of cancer in these organs.

Although very rare, the newly created penis and/or scrotum may develop cancers of the skin or mucosal lining. The type of cancer depends on the tissues used during surgery, and some are associated with persistent HPV infection.

As with penile and tescitular cancer in people born with these organs, there are no established screening tests. Early detection relies on recognising suspicious changes or symptoms and seeking medical advice promptly if these occur.

For more information, see Penile and testicular cancer awareness.