Vulvar self-exam: taking charge of your own health

Vulvar self-exam

Unlike the widely available information about breast self-exam, few women have heard about vulvar self-exam. The purpose of examining the vulva is to detect early symptoms of vulvar disorders or even vulvar cancer. Because phrases like “down there” or “private parts” are often used to describe a woman’s genitals, and even the word “vagina” is often mistakenly used to refer to the vulva, some women might be confused about what a vulva is. Before discussing how to perform vulvar self-exam, we need to understand what is meant by the word “vulva.”

What is the vulva?

The word “vulva” refers to several parts that compose the external area of a woman’s genitals. Learning the names of these different parts will help you communicate the exact location of any changes in your vulva to your doctor. The Figure shows the different parts that make up the vulva.

The mons pubis is the area that sits on top of your pubic bone and is covered with pubic hair. The labia majora, often called the “outer lips,” are the two larger folds of skin that enclose much of the vulva. The labia minora, sometimes called the “inner lips,” are folds of skin on either side of the vaginal entrance and are hairless. The urethra, through which women urinate, is seen above the vaginal entrance. The clitoris sits above the urethra, at the 12 o’clock position, and the perineum—the area between the anus and the vagina—is near the 6 o’clock position. The perianal area is the area around the opening of the anus

Individual differences

The color of the vulva varies for each woman—it could be light or dark pink, grayish, or black. Similarly, the shape and size of vulvar parts is different for each woman—a woman’s clitoris and labia may be small or large. These differences make it even more important for you to start performing vulvar self-exams early, so that you can note what looks “normal” for you and track any changes that may occur.

Why is it important to perform vulvar self-exams?

The majority of vulvar cancer patients are over the age of 50, but vulvar cancer appears to be increasing among women under 50. Vulvar cancer has high survival rates when it is detected early, before it spreads to the lymph nodes. Diagnoses are often needlessly delayed for lack of awareness of symptoms by patients and their clinicians.

Performing regular vulvar self-exams can help detect vulvar cancer early and may help save your life. Even though vulvar cancer typically progresses slowly, some rare types grow rapidly. When vulvar cancer is detected in an early stage, it is highly curable. By doing the vulvar exam you will also be able to detect any noncancerous vulvar disorders that may develop, and seek early treatment.

How often should I perform this exam?

Although most gynecologists will include an examination of vulvar skin as part of a woman’s annual exam, all women who are sexually active should perform monthly vulvar self-exams, in between menstrual periods, preferably at the same time each month. All women 18 years or older should perform this exam, even if they are not sexually active. Women with a history of vulvar disorders—such as lichen sclerosus, lichen planus, vulvar intraepithelial neoplasia, or vulvodynia—are particularly encouraged to perform this exam on a regular basis.

Are some women at increased risk for vulvar cancer?

Yes. Women who have had the human papilloma virus (HPV) and women who smoke may be at increased risk for vulvar cancer. In addition, women who are older than 50 years and those with a history of vulvar disorders may be at increased risk. However, vulvar cancer can occur at any age, and regardless of medical history.

Looking for changes

How do I perform the exam?

Follow these simple steps for a thorough vulvar self-exam:

  • Make sure you have enough light so that you can see well.
  • Sit down on a comfortable surface, such as a bed or rug. Some women find it more comfortable to stand with one foot propped up on a chair or bed.
  • Hold a mirror in one hand and use the other hand to inspect the vulva.
  • Examine the parts of the vulva by sight and by touch: the mons pubis, the left and right folds of the labia majora, the left and right folds of the labia minora, the clitoris and its general area, the skin around the vaginal entrance, the perineum, and the perianal area.

What Am I Looking For?

Follow these simple steps for a thorough vulvar self-exam:

  • Observe any changes in appearance, such as a new mole, wart, lump, or other growth; changes in skin color, such as white, reddened, or brown patches of skin; cuts or sores.
  • Observe any changes in the feel of the skin, such as areas where you feel pain, itching, inflammation, or other discomfort.
  • While visually inspecting the vulva, gently press or palpate the vulvar skin to check for any lumps.
  • Report any changes in appearance or feel to your doctor immediately.

In addition to visually examining your vulva, feeling for any textural changes, such as lumps or sore areas, may help detect symptoms of vulvar disorders or even vulvar cancer.

Don’t ignore vulvar itching

Vulvar itching is the most common symptom of vulvar cancer, but many women feel embarrassed to mention it to their doctor, or they may ignore it, attributing the itch to an allergic reaction, a yeast infection, or similar problems. Although in most cases vulvar itching will not be cancerous, it should not be ignored, particularly if the itching is persistent, intensifies, or is accompanied by the development of a sore, lump, or mole.

If I notice skin changes, does it mean I have cancer?

Not all skin changes will be cancerous. Skin changes may signify an allergy or a vulvar disorder, many of which are easily treated—particularly when detected early. Whatever changes you find, you should report them to your doctor as soon as possible. Early detection increases your chances for successful treatment.
Ask your doctor if you have any questions about vulvar problems.

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