What to do about lumps on the vagina or vulva

Your vulva - that's the external area which includes your labia, as opposed to the vagina where you can only see the entrance - can develop soreness, lumps and bumps.

Many women, according to gynaecological cancer charity the Eve Appeal, feel uncomfortable about examining their vulvas, but this should be part of a health check you carry out every few weeks - no different to checking your breasts.

Thirty years of discomfort

Ever since she was a child, Clare Baumhauer, 45, had symptoms of severe itching and soreness on her vulva. Over many years she was told it was possibly thrush, diabetes and, in her late thirties, menopause, although she was not menopausal.

Baumhauer's symptoms came and went for over thirty years, with some doctors not even examining her.

"I didn't even know the word 'vulva' so I'd say I had an itch or soreness and doctors would assume it was thrush. I treated myself with over-the-counter treatments a lot of the time," Baumhauer reveals.

But then, in her late thirties, her skin tore.

"I thought it was a result of sex, but the tear eventually became an ulcer, about the size of a 5p coin then it grew to the size of a 10p coin. It was so sore I could hardly sit down," she recalls.

"Within weeks I’d had three biopsies which showed I had lichen sclerosus and vulval cancer. I had in fact been suffering with lichen sclerosus all my life and was one of the 5% of women where it develops into cancer."

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Lichen sclerosus

Lichen sclerosus is a skin condition which affects women and men, though it's not contagious. The signs include: itching of the vulva, white patches of skin that can look silvery, and soreness of the skin which is fragile so it can tear easy. Sometimes the condition progresses to a painful sore.

Women of all ages can have lichen sclerosus. It's often diagnosed later in life when some women have symptoms related to menopause and seek help for soreness or vaginal dryness, but it can affect younger women too.

It's easy for lichen sclerosus to be dismissed as thrush, or herpes, and diagnosis is usually through a biopsy and specialist treatment from a dermatologist or gynaecologist. There is no outright cure but it can be controlled through treatment. Treatment is usually with steroid creams and skin care avoiding irritants.

Because lichen sclerosus can develop into vulval cancer, early diagnosis and treatment are essential.

"Needless to say, I was shocked," says Baumhauer. "I was 43, up to date with my smear tests, and couldn't understand how something so serious had been undiagnosed."

But checks on vulval health are not part of screening for cervical cancer, so you should not assume your doctor or nurse will notice anything when you go for your smear.

We need to talk about vulval cancer

Karen Hobbs, cancer information officer for the Eve Appeal says: "There are 1,300 new cases of vulval cancer diagnosed each year. This compares with 3,000 cases of cervical cancer each year."

So what signs of vulval cancer should you look for? Hobbs says: "You should look for any of these signs and see your doctor if you find any."

• A persistent itch of the vulva, pain or soreness.

• Skin that is thickened, red, raised, or with white or dark patches.

• An open sore or visible growth.

• A mole or swelling that grows or changes colour.

• A lump or swelling.

Other risk factors for vulval cancer include: vulval intraepithelial neoplasia (changes to the vulval cells), HPV and smoking.

Treatment depends on the stage of the cancer. It almost always involves surgery, to the affected area but also the lymph nodes if necessary, along with additional treatment such as radiation if the cancer has spread.

Baumhauer says: "My treatment involved surgery on my labia, and radiotherapy. The lymph nodes in my groin showed the cancer had spread, it was now Stage 3 and more radiotherapy was needed. I am now in remission with a 40% chance of living beyond the next five years."

What might you find on your vulva?

Vulval cancer is thankfully rare, and there are many other reasons for finding lumps and bumps in that area. But it's still important to get checked out if you notice anything that's not normal for you.

Spots and cysts

Spots can come and go quickly. They can be caused by an inflamed hair follicle or an ingrowing hair and will usually disappear within a week or so. Cysts can occur in the sebaceous glands. One of the largest glands is the Bartholin's gland near the vaginal entrance. If blocked, it may grow in size - some can grow as large as an egg - and need treatment such as minor surgery and antibiotics.

STI symptoms

Through sexual contact, you may become infected with herpes, genital warts, or syphilis. Although herpes and warts can be unpleasant, undiagnosed syphilis is more serious.

The first sign of syphilis in women is usually a painless sore on the vulva or inside the vagina (which you can't see.) This sore disappears within a few weeks, but without treatment at this first stage, the infection progresses to the next more serious stage. It's vitally important to seek medical help if you think you could have caught syphilis, which can eventually be fatal if not treated. Your local sexual health clinic offers confidential help.

Vaginal lumps and bumps

It's harder to see if anything is wrong with your vagina because it's all inside. But if you notice anything unusual, see your doctor.

Vaginal cancer is very rare - only 250 cases in the UK annually and mostly in women over sixty - but it needs treatment as soon as possible.

The symptoms you need to have checked out include:

• Unexpected bleeding - eg, between periods, after menopause or after sex.

• Vaginal discharge that smells or may be bloodstained.

• Vaginal pain during sexual intercourse.

• A vaginal lump or growth that you or your doctor can feel.

• A vaginal itch that won't go away and pain when urinating.

• Persistent pelvic and vaginal pain.

Saying 'vagina' or 'vulva' shouldn't make you blush

Above all, don't be embarrassed to talk with a doctor about your symptoms or to use the words 'vulva' and 'vagina' when explaining your symptoms, says Hobbs.

"We often refer to our 'vulva' as our 'vagina', but we need to know the difference. Vulva is external, vaginal is internal. The symptoms for vulval and vaginal cancers can actually vary quite a bit - eg, a smelly vaginal discharge (vaginal cancer symptom) and raised/reddened skin (vulval cancer symptom).

"It's so important for us to know the correct names for our body parts. If we don't know what to call our vulva for example, then it makes it so much harder to communicate with a GP/medical professional when there is a problem. The more we know about our bodies and what's normal for us, the more likely we are to notice when something changes," she concludes.