Vulva and Vagina

Conclusions Vulvar and vaginal cancer precursor lesions are predominantly squamous cell neoplasias that contain HPV DNA. Other risk factors that are similar to CIN include current smoking, a history of prior genital warts or anogenital neoplasia, and multiple sexual partners. Unlike cervical cancer, vulvar and vaginal neoplasias are rare, and prevention beyond visual examination is not a part of routine gynecologic care. Women with impaired immunity (e.g., organ transplant recipients, acquired immunodefi- ciency syndrome patients, and patients who are treated with corticosteroids) should be screened periodically. A history of previous HPV-related diseases should be obtained in these women before determining the frequency of cytologic screening. The overall patterns of incidence seem to be similar between vulvar and vaginal cancers in the United States. The incidence of VIN3 is increasing more sharply than that of VAIN3, but the incidence of invasive vaginal and vulvar cancer remains steady or has started to decline. Outstanding questions concerning the etiology and prevention of in situ vulvar cancer are becoming more important as the incidence rate has increased. There are few studies of these rare lesions, but future studies will give us a more thorough understanding of their natural history and etiology.