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Cancer Health Center

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I Had the Cancer No One Talks About

After extreme gynecological surgery, writer Darci Picoult dug deep and found a whole new level of intimacy.

Vulva. There, we said it. Now here’s what you need to know about it.

1. Exactly where it is! We use so many euphemisms, from "down there" to "va-jay-jay," that it's no surprise many women aren't sure what the vulva is. Answer: the inner and outer labia, clitoris, and pubic mound, explains David A. Fishman, M.D., director of gynecologic oncology research at Mount Sinai School of Medicine in New York City.

2. How to tell if something is wrong.Vulvar cancer is relatively rare - about one in 387 women will get it in her lifetime, compared with one in eight for breast cancer. But survival rates are lower, around 75 percent, so it's important to catch it early, Fishman says. "Knowing your body is critical," he says. Some signs of potentially cancerous changes:

• Sores or wartlike bumps that don't heal after four days.
• Skin that is thicker or a different color than the skin around it (tiny yellow dots on the inner labia are an exception - those are most likely just sebaceous glands).
• Dark, irregularly shaped moles or spots.

3. How to protect yourself. Get a yearly pelvic exam, even if you're not due for a Pap, and ask your doctor about a human papillomavirus (HPV) test. It's estimated that 40 percent of vulvar cancers are related to HPV - the virus that causes most cases of cervical cancer.

Darci is a Sundance playwriting and screenwriting fellow whose work has been produced regionally and in New York City. Her play My Virginia is available at and on iTunes. Her latest film, Mother of George, is slated to start production soon, with Kerry Washington attached to star.

Originally Published on December 21, 2010

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