Obstetrics, Gynecology and Reproduction

Advanced search

Background and precancerous processes in the vulva and vagina: etiology, pathogenesis, diagnosis and treatment

Full Text:


Leukoplakia, kraurosis and pointed condylomas (papillomas) of the vulva represent the group of background benign vulvar diseases. Vulvar and vaginal intraepithelial neoplasms are classified as premalignant conditions. The etiology and pathogenesis of these diseases are not entirely clear due to their complexity. Despite the easy visual assessment of anatomic areas involved in the pathological process, these diseases are rarely diagnosed at an early stage, which might indicate insufficient vigilance of doctors and patients in relation to the early symptoms. Therefore, this field of oncogynecology needs further development ln terms of diagnosisprevention, screening and treatment.

About the Authors

A. G. Solopova
I.M. Sechenov First Moscow State Medical University
Russian Federation

MD, PhD, Professor, Department of Obstetrics and Gynecology, Faculty of Clinical and Preventive Medicine

62 St. Zemlyanoi Val, Moscow 109004, Russia

E. V. Tselovalnikova
I.M. Sechenov First Moscow State Medical University
Russian Federation

Clinical Resident, Department of Pediatrics and Pediatric Infectious Diseases, Faculty of Pediatrics

62 St. Zemlyanoi Val, Moscow 109004, Russia

V. S. Moskvichyova
I.M. Sechenov First Moscow State Medical University
Russian Federation

Clinical Resident, Department of Sports Medicine and Medical Rehabilitation, Faculty of General Medicine

62 St. Zemlyanoi Val, Moscow 109004, Russia

T. A. Blbulyan
Yerevan State Medical University named after Mkhitar Heratsi

Assistant, Department of Obstetrics and Gynecology

2 Koryun St., Yerevan 0025, Armenia

A. S. Shkoda
City Clinical Hospital № 67 named after L.A. Vorokhobov
Russian Federation

MD, PhD, Professor, Chief Physician

2/44 Salyama Adilya St., Moscow 123423, Russia

A. D. Makatsariya
I.M. Sechenov First Moscow State Medical University
Russian Federation

MD, PhD, Corresponding Member of RAS, Professor, Head of the Department of Obstetrics and Gynecology, Faculty of Clinical and Preventive Medicine

62 St. Zemlyanoi Val, Moscow 109004, Russia


1. Lai J., Elleray R., Nordin A. et al. Vulval cancer incidence, mortality and survival in England: age-related trends. BJOG. 2014;121(6):728–38.

2. Malignant neoplasms in Russia in 2014 (morbidity and mortality). [Zlokachestvennye novoobrazovaniya v Rossii v 2014 godu (zabolevaemost' i smertnost'). Pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoj]. Moskva: MNIOI im. P.A. Gercena – filial FGBU «NMIZC» MZ RF, 2016. 250 p (in Russ.).

3. Bleeker M.C., Visser P.J., Overbeek L.I. et al. Lichen sclerosus: incidence and risk of vulvar squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 2016;25(8):1224–30.

4. Alkatout I., Schubert M., Garbrecht N. et al. Vulvar cancer: epidemiology, clinical presentation, and management options. Int J Womens Health. 2015;20(7):305–13.

5. Chhabra S., Bhavani M., Deshpande A. Trends of vulvar cancer. J Obstet Gynaecol. 2014;34(2):165–8.

6. Koh W.J., Greer B.E., Abu-Rustum N.R. et al. Vulvar cancer, version 1.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2017;2015(1):92–120.

7. Kraposhina T.P., Filyushkina A.Yu., Antonyan M.G. Etiology, pathogenesis and treatment of sclerosing lichen of the vulva (review). [Etiologiya, patogenez i lechenie skleroziruyushchego lishaya vul'vy (obzor literatury)]. Vestnik RGMU. 2014;(3):41–5 (in Russ.).

8. Boero V., Brambilla M., Sipio E., Liverani C.A. Vulvar lichen sclerosus: A new regenerative approach through fat grafting. Gynecol Oncol. 2015;139(3):471–5. DOI: 10.1016/j.ygyno.2015.10.014.

9. Blbulyan T.A., Klimova O.I., Pogasov A.G., Sokhova Z.M. Perineum dystrophic diseases in menopausal period. [Distroficheskie bolezni promezhnosti v menopauzal'nom periode]. Vestnik RUDN. Seriya: Meditsina. 2016;(2):135–7 (in Russ.).

10. Preti M., Scurry J., Marchitelli C.E., Micheletti L. Vulvar intraepithelial neoplasia. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1051–62.

11. Bradbury M., Cabrera S., García-Jiménez A. et al. Vulvar intraepithelial neoplasia: clinical presentation, management and outcomes in women infected with HIV. AIDS. 2016;30(6):859–68.

12. Ghisu G.P., Fink D. Burning vulva: significance of surgery in inflammatory and precancerous vulvar pathologies. Praxis (Bern 1994). 2015;104(13):689–93.

13. Schuurman M.S., van den Einden L.C., Massuger L.F. et al. Trends in incidence and survival of Dutch women with vulvar squamous cell carcinoma. Eur J Cancer. 2013;49(18):3872–80.

14. Clinical protocol for diagnosis and treatment «Non-inflammatory diseases of vulva and perineum». 2016. [Klinicheskij protokol diagnostiki i lecheniya «Nevospalitel'nye zabolevaniya vul'vy i promezhnosti»] (in Russ.). Available at: [Accessed: 15.09.2018].

15. Tristram A., Hurt C.N., Madden T. et al. Activity, safety, and feasibility of cidofovir and imiquimod for treatment of vulval intraepithelial neoplasia (RTіVIN): a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2014;15(12):1361–8.

16. Reutskaya M.A., Kulinich S.I. Microbiological and morphological rationale for the diagnosis and treatment of vulva diseases. [Mikrobiologicheskoe i morfologicheskoe obosnovanie diagnostiki i lecheniya zabolevanij vul'vy]. Sibirskij medicinskij zhurnal (Irkutsk). 2012;(1):54–7 (in Russ.).

17. Solopova A.G., Makatsaria A.D., Ivanov A.E., Malandin A.G. Precancer and cancer of the female external genital organs. [Predrak i rak zhenskih naruzhnyh polovyh organov]. Moskva: MIA, 2007. 80 p (in Russ.).

18. Chovanec J., Mouková L., Feranec R. Preinvasive lesions in gynecology – vulva. Klin Onkol. 2013;26(Suppl):S44–6.

19. Schierbeck L.L., Rejnmark L., Tofteng C.L. et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. Br Med J. 2012;345:e6409.

20. Pérez-López F.R., Ceausu I., Depypere H. et al. EMAS clinical guide: vulvar lichen sclerosus in peri- and postmenopausal women. Maturitas. 2013;74(3):279–82.

21. Reutskaya M.A., Kulinich S.I. Vulvar dystrophy or chronic vulvitis? Microbiological and morphological verification. [Distrofiya vul'vy ili hronicheskij vul'vit? Mikrobiologicheskoe i morfologicheskoe obosnovanie]. Sibirskij medicinskij zhurnal (Irkutsk). 2012;(2):66–69 (in Russ.).

22. Ganovska A., Kovachev S. Vulvar intraepithelial neoplasia – terminology, symptoms and treatment. Akush Ginekol (Sofiia). 2015;54(7):36–40.

23. Baker G.M., Selim M.A., Hoang M.P. Vulvar adnexal lesions: a 32-year, single-institution review from Massachusetts General Hospital. Arch Pathol Lab Med. 2013;137(9):1237–46.

24. Reutter J.C., Walters R.A., Selim M.A. Differentiated vulvar intraepithelial neoplasia: What criteria do we use in practice? J Low Genit Tract Dis. 2016;20(3):261–6.

25. Reyes M.C., Cooper K. An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis. J Clin Pathol. 2014;67(4):290–4. DOI: 10.1136/jclinpath-2013-202117.

26. Fistarol S.K., Itin P.H. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013;14(1):27–47.

27. Nelson E.L., Bogliatto F., Stockdale C.K. Vulvar intraepithelial neoplasia (VIN) and condylomata. Clin Obstet Gynecol. 2015;58(3):512–25.

28. Makarov O.V., Khashukoeva A.Z., Kupeeva E.S. et al. Treatment of vulva dystrophic diseases by photodynamic therapy. [Lechenie distroficheskih zabolevanij vul'vy metodom fotodinamicheskoj terapii]. Vestnik RGMU. 2014;(4):49–52 (in Russ.).

29. Gentile M., Bianchi P., Sesti F. et al. Adjuvant topical treatment with imiquimod 5 % after excisional surgery for VIN 2/3. Eur Rev Med Pharmacol Sci. 2014;18(19):2949–52.

30. Gynecology: a textbook. [Ginekologiya: uchebnik. Pod red. G.M. Savel'evoj, V.G. Breusenko]. Moskva: GEOTAR-Media, 2012. 432 p (in Russ.).

31. Sakhautdinova I.V., Simakova E.L. Comparative analysis of treatment results of scleroatrophic lichen using allogeneic biomaterials and local glucocorticoids. [Sravnitel'nyj analiz rezul'tatov lecheniya skleroatroficheskogo lihena s primeneniem allogennyh biomaterialov i mestnyh glyukokortikoidov]. Zdorov'e i obrazovanie v XXI veke. 2016;18(7):35–9 (in Russ.).

32. Boyko A.V., Demidova L.V., Dunaeva E.A. et al. The possibilities of radiation therapy as an alternative to surgical treatment in patients with vulvar cancer. I National Congress «Oncology of the reproductive organs: from prevention and early detection to effective treatment»: abstracts. [Vozmozhnosti ispol'zovaniya luchevoj terapii v kachestve al'ternativy hirurgicheskomu lecheniyu u bol'nyh rakom vul'vy. I Nacional'nyj kongress «Onkologiya reproduktivnyh organov: ot profilaktiki i rannego vyyavleniya k effektivnomu lecheniyu»: tezisy dokladov]. Moskva: Kvazar, 2016. 44–3 (in Russ.).

33. Brauer M., van Lunsen R., Burger M., Laan E. Motives for vulvar surgery of women with lichen sclerosus. J Sex Med. 2015;12(12):2462–73.

34. Ribeiro F., Figueiredo A., Paula T., Borrego J. Vulvar intraepithelial neoplasia: evaluation of treatment modalities. J Low Genit Tract Dis. 2012;16(3):313–7.

35. Grebenkina E.V., Gamayunov S.V., Onoprienko O.V. et al. PDT diseases of vulva. [FDT zabolevanij vul'vy]. Rossijskij bioterapevticheskij zhurnal. 2012;11(2):13 (in Russ.).

36. Makarov I.O., Chulkova E.A., Sheshukova N.A., Makarova I.I. [Neopuholevye zabolevaniya vul'vy]. Non-neoplastic diseases of the vulva. Akusherstvo i ginekologiya. 2012;6(2):14–7 (in Russ.).

37. Suleymanova N.D. Risk factors for malignant tumors of the female genital organs. [Faktory riska zlokachestvennyh novoobrazovanij zhenskih polovyh organov]. Vestnik novyh medicinskih tekhnologij. 2014;21(1):115–21 (in Russ.).

38. Filonenko E.V., Chulkova OV, Serova L.G. Possibilities of photodynamic therapy in the treatment of degenerative diseases, intraepithelial neoplasias and vulvar cancer. [Vozmozhnosti fotodinamicheskoj terapii v lechenii distroficheskih zabolevanij, intraepitelial'nyh neoplazij i raka vul'vy]. Rossijskij bioterapevticheskij zhurnal. 2016;15(1):110–1 (in Russ.).

39. Filonenko E.V., Chulkova OV, Serova L.G. Photodynamic therapy of degenerative diseases, precancer and cancer of the vulva. [Fotodinamicheskaya terapiya distroficheskih zabolevanij, predraka i raka vul'vy]. Research'n Practical Medicine Journal (specvypusk), 2016. 177 (in Russ.).

40. Lawrie T.A., Nordin A., Chakrabarti M. et al. Medical and surgical interventions for the treatment of usual-type vulval intraepithelial neoplasia. Cochrane Database Syst Rev. 2016;1:CD011837. DOI: 10.1002/14651858.CD011837.pub2.

41. Malandin A.G., Solopova A.G., Filinov V.L. A new method for treatment of dysplastic processes of pudendums. [Novyj metod lecheniya displasticheskih processov zhenskih naruzhnyh polovyh organov]. Medicinskie nauki. 2005;(2):12 (in Russ.).

42. Klapdor R., Hillemanns P., Wölber L. et al. Outcome after sentinel lymph node dissection in vulvar cancer: a subgroup analysis of the AGO-CaRE-1 Study. Ann Surg Oncol. 2017;24(5):1314–21. DOI: 10.1245/s10434-016-5687-0.

43. Stier E.A., Goldstone S.E., Einstein M.H. et al. Safety and efficacy of topical cidofovir to treat high-grade perianal and vulvar intraepithelial neoplasia in HIV-positive men and women. АIDS. 2013;27(4):545–51.


For citations:

Solopova A.G., Tselovalnikova E.V., Moskvichyova V.S., Blbulyan T.A., Shkoda A.S., Makatsariya A.D. Background and precancerous processes in the vulva and vagina: etiology, pathogenesis, diagnosis and treatment. Obstetrics, Gynecology and Reproduction. 2018;12(4):52-61. (In Russ.)

Views: 1287

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)