Read about tests you may have to diagnose vulval cancer
What tests will I have?
You often have a vaginal and pelvic examination when you go to see a specialist at the hospital. You may also have other examinations to help find out what is causing your symptoms.
It’s understandable that some women can find these examinations embarrassing and invasive. It can also be uncomfortable. Your specialist will do all they can to make you comfortable and put you at ease.
Contact the number on the appointment letter beforehand if you think you are going to find these examinations difficult and upsetting. If the medical team know how you feel, they can make sure you get the support you need and allow more time if necessary.
For this examination, you lie down on your back with your knees up and legs apart. You may be asked to rest your legs up on padded leg supports. The specialist might use a strong light and magnifier to look at the vulva area. They check for any changes or abnormalities.
The specialist may want you to have a biopsy. This means removing a sample of tissue from any suspicious areas in the vulva. This is the only way to confirm whether or not you have abnormal cells or cancer. This is usually on the same day as your hospital appointment.
Your specialist might do a pelvic examination. Your pelvis is the area between your hip bones. It contains the pelvic organs, including the reproductive organs and the bladder and lower bowel.
You usually lie on your back on the couch, as for your vulval examination. If you cannot get into that position for any reason, they may be able to examine you while you are lying on your side with your knees drawn up.
The doctor puts two gloved fingers into your vagina. And at the same time they press down on your tummy (abdomen) with their other hand. They may also check your back passage (rectum). They can feel for any lumps or changes in size or shape.
The doctor will probably use a speculum and colposcope to see inside your vulva and vagina. A speculum is the metal or plastic instrument that your doctor or nurse use to spread the walls of the vagina (for example when you have a cervical smear). A colposcope is like a microscope that helps the doctor to find any abnormality that might be too small to see with the naked eye.
The specialist will put in the speculum first to open up the vagina. They might then look through the colposcope to examine the inside of the vagina and neck of the womb (cervix). The colposcope does not go inside your vagina. The doctor looks through it from the outside. They might take a biopsy of any abnormal areas.
You may find it uncomfortable to be in one position during the examination. The examination and biopsy are not usually painful. But some women have tummy (abdominal) cramps for a few minutes.
Your specialist may also feel the lymph nodes in your groin, to see if they are larger than usual.
Before any examination, your GP or specialist will explain what they are going to do. But do ask if you are not clear about anything.
Examination under anaesthetic (EUA)
It may be too uncomfortable for some people to have an examination while they are awake. So in this situation, you may have a general anaesthetic. The doctor can examine the vulva, vagina and cervix without it being uncomfortable for you.
During this examination, the doctor may do further tests to check for any signs of cancer spread. Although not very common, it is possible for large cancers to spread into the bladder or back passage (rectum). So you may need to have a bladder examination (cystoscopy) and, or a rectal examination.
Your specialist will explain exactly what they are going to do beforehand.
A test to check your bladder
An examination of the inside of your bladder is called a cystoscopy.
Test to check your back passage (rectum)
The specialist may put a gloved finger inside your back passage (rectum), to feel for abnormalities, or to do a more detailed rectal examination, they may use an instrument called a proctoscope. This shows the rectal wall very clearly.
With either of these examinations, the specialist may take biopsies of any abnormal areas.
After your examination
You will usually be able to go home once your examinations are over. Some women might need to stay overnight if they have had a general anaesthetic. But most can go home the same day.
Before you leave hospital make sure you know how you will be given the results. They might ask you to go back to the hospital for an outpatient appointment to see the specialist. Or they might send the results in the post.