The vulva
The vulva is a general term for a woman’s external sexual organs (genitals). The main parts of the vulva are the:
- mons pubis – the soft, fatty mound of tissue covered with pubic hair, above the labia
- labia majora – two large, outer fleshy lips, which surround the inner lips known as labia minora
- labia minora – two inner lips (may be smaller or thinner than the labia majora)
- clitoris – the main organ for sexual pleasure in women. It is located where the labia minora join at the top of the vulva. During arousal, the clitoris fills with blood and becomes erect, and its stimulation can lead to sexual climax (orgasm)
- Bartholin glands – two small glands near the opening of the vagina. They produce mucus to lubricate the vagina.
The vagina
Sometimes called the birth canal, the vagina is a muscular channel about 7-10 cm long that extends down from the cervix (neck of the uterus) to the vulva. The vaginal opening is where menstrual blood flows out of the body, sexual intercourse occurs, and a baby is born.
Urethra, anus and perineum
Below the clitoris is the urethra, for passing urine. Further down is the entrance to the vagina, and behind that is the anus. The area of skin between the vagina and the anus is called the perineum.
Making treatment decisions
Sometimes it is difficult to decide on the type of treatment to have. You may feel that everything is happening too fast, or you might be anxious to get started. Check with your specialist how soon treatment should begin – often it won’t affect the success of the treatment to wait a while. Ask them to explain the options, and take as much time as you can before making a decision.
Know your options
Understanding the disease, the available treatments, possible side effects and any extra costs can help you weigh up the options and make a well-informed decision.
Record the details
When your doctor first tells you that you have cancer, you may not remember everything you are told. Taking notes or recording the discussion can help. It is a good idea to have a family member or friend go with you to appointments to join in the discussion, write notes or simply listen.
Consider a second opinion
You may want to get a second opinion from another specialist to confirm or clarify your specialist’s recommendations or reassure you that you have explored all options.
Specialists are used to people doing this. Your general practitioner (GP) or specialist can refer you to another specialist and send your results to that person. You can get a second opinion even if you have started treatment or still want to be treated by your first doctor. You might decide you would prefer to be treated by the second specialist.
It’s your decision
Adults have the right to accept or refuse any treatment that they are offered. For example, some people with advanced cancer choose treatment that has significant side effects even if it gives only a small benefit for a short period of time. Others decide to focus their treatment on quality of life. You may want to discuss your decision with the treatment team, GP, family and friends. See Cancer Care and Your Rights.
Should I join a clinical trial?
Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led
to better outcomes for people diagnosed with cancer.
You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.
Which health professionals will I see?
Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, such as a gynaecologist or gynaecological oncologist. The specialist will arrange further tests. If vulvar or vaginal cancer is diagnosed, the specialist will consider treatment options. Often these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting.
During and after treatment, you will see a range of health professionals who specialise in different aspects of your care. To ensure the best outcome, it is recommended that you are treated in a specialist centre for gynaecological cancer. Call Cancer Council 13 11 20 for information about specialist centres in your area or to ask about assistance that may be available if you have to travel a long way for treatment.
| Health professionals you may see | Role |
| GP | assists with treatment decisions; provides ongoing care in partnership with specialists |
| gynaecologist* | specialises in diseases of the female reproductive system; may diagnose vulvar or vaginal cancer and then refer you to a gynaecological oncologist |
| gynaecological oncologist* | diagnoses and performs surgery for cancers of the female reproductive system (gynaecological cancers), such as vulvar and vaginal cancers |
| radiation oncologist* | treats cancer by prescribing and overseeing a course of radiation therapy |
| medical oncologist* | treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy |
| reconstructive/plastic surgeon* | performs surgery that restores, repairs or reconstructs the appearance and function of the genitals after the cancer is removed |
| nurses | administers drugs and provides care, information and support throughout treatment |
| cancer care coordinator | coordinates your care, liaises with MDT members, and supports you and your family throughout treatment; may be a clinical nurse consultant (CNC) or specialist (CNS) |
| psychiatrist*, psychologist, counsellor | helps you manage your emotional response to diagnosis and treatment; may also help with emotional issues affecting sexuality |
| social worker | links you to support services and helps you with emotional, practical and financial issues |
| dietitian | recommends an eating plan to follow while you are in treatment and recovery |
| women’s health physiotherapist | treats physical problems associated with treatment for gynaecological cancers, such as bladder and bowel issues, sexual issues and pelvic pain |
*Specialist doctor