Usually you begin by seeing your GP, who will examine you. If there is any possibility of you having vulval cancer you should be referred to a gynaecological cancer specialist (specialist in women’s cancers). Your doctor may also arrange for you to have a blood test and chest x-ray to check your general health.

At the hospital the gynaecologist will take your medical history and will examine your vulval area. They may also carry out some tests. The nurse will help you to position yourself on a couch that has special leg supports. Understandably, some women find this kind of examination embarrassing or upsetting. If you feel like this let your doctor or nurse know so that they can support you emotionally.

To examine your vulva the doctor may use a colposcope. This helps to identify any abnormal areas. The colposcope is like a small microscope with a bright light that can magnify areas so that the cells can be seen more clearly. The colposcope stays outside the body. A biopsy will be taken.

You will also have an internal examination to check your vagina and cervix for any abnormality. The doctor will use a speculum (a plastic or metal instrument) to hold the vaginal walls open. A liquid is then dabbed on to the cervix to make any abnormal areas show up more clearly. A colposcope is used to examine the cervix. Sometimes a small sample of cells from the cervix will be taken. Some women with lichen planus or lichen sclerosus can have narrowing of the vagina. In this situation it may be necessary to have the sample of cells taken under a general anaesthetic.

The doctor may also examine your back passage (anus) to check for any abnormal lumps. The skin around your back passage may be examined.

Biopsy

This procedure can usually be done in the outpatients clinic. Anaesthetic cream is applied to the vulva to numb the area, and then an injection of local anaesthetic is given. The doctor takes the biopsy (a small amount of cells) from the abnormal area using a biopsy instrument. The biopsy is examined under a microscope by a pathologist. This is the best way of diagnosing cancer of the vulva. Because the local anaesthetic numbs the area there should be no pain, but you may feel a little discomfort during the biopsy. Afterwards, you may have slight bleeding (let your doctor know if it is more than this), and slight soreness. The soreness can be relieved with mild painkillers and a warm bath. The doctor will usually see you about 7–10 days after the biopsy to give you the results. Waiting for the results can be a stressful time and support organisations can help you to cope.