Surgery for vulval intraepithelial neoplasia (VIN)
VIN is when abnormal cells develop in the surface layers of the skin covering the vulva. It is not vulval cancer but could turn into cancer.
Treatment for VIN is usually surgery or treatment with a cream called imiquimod.
Types of surgery for VIN
The type of surgery you have depends on how much of your vulva the VIN is affecting. The most common operation is called a wide local excision. More rarely some women need an operation called a skinning vulvectomy.
Wide local excision
Wide local excision is when your surgeon removes the area of skin affected by VIN and a border of healthy tissue around it. This is called a margin.
How much skin your surgeon will need to remove depends on how big an area of the vulva is affected.
Skinning vulvectomy
Rarely, if the VIN is affecting a large area, your surgeon may need to do an operation called a skinning vulvectomy. This means removing the skin over a large area. Because the abnormal cells are only on the vulval surface, it is possible to remove only the skin and leave the healthy tissue underneath.
The surgeon may be able to stitch the remaining skin back together. Or you may need a skin flap or skin graft to repair the area, but your surgeon will avoid doing this if they can.
A skin flap is an area of healthy skin with its blood supply, which is moved from close by to cover the area where the skin has been removed.
Skin grafting is used less often than a skin flap. Grafting means your surgeon takes some healthy skin from another part of your body and stitches it over the site of the operation. The healthy skin is most often taken from your inner thigh. This is called the donor site. The donor site will heal on its own over a few weeks.
This diagram below shows the area of skin the surgeon will remove during the operation.
The second diagram shows the vulva after the removal of the skin.
This third diagram shows the vulva after the skinning vulvectomy operation. Once the area has healed, you should have smooth, neat lines of scar tissue. The opening of the bladder (urethra), the clitoris and the vagina stay in the same place as before the operation.
After surgery for VIN
It can help to know what to expect when you wake up. You usually wake up in the recovery room in theatre. You go back to the ward as soon as you're awake and stable.
You'll feel drowsy for a while because of the 
and painkillers.
How long you stay in hospital depends on the type of surgery you have. Some people may be able to go home on the same day.
Tubes
You might have a tube (catheter) put into your bladder while you are in theatre. Depending on the operation you've had, this may only stay in overnight. Or you may need it in for a longer period of time. The catheter will drain urine from your bladder.
Your wound
You usually don't have a dressing covering your wound. A normal sanitary pad is used instead. This is so you can clean the wound regularly with lukewarm water.
The stitches are usually soluble, so you don't have to have them taken out. Sometimes they become tight and can be removed after 10 days. Your nurse and doctor will tell you how to look after your wound before you go home.
Coping with surgery for VIN
VIN affects a deeply personal and private part of your body. A few people prefer not to know about their operation in advance. But it may help you to cope better if you understand exactly what is going to happen.
Some women may choose to look at the vulval area soon after surgery. Others may prefer to wait. There is no right or wrong way and it is important that you feel supported when you are ready to look. Your nurse can be with you the first time you do this.
Most hospitals have a clinical nurse specialist (CNS) that supports women having this type of treatment. This nurse is there to answer your questions or just talk about how you are feeling.
There should be information available for you to take home with you. Ask your surgeon or clinical nurse specialist for a booklet or printed web pages that you can read through yourself. This will help you to work out what questions you need to ask next time you go to the hospital. Or you can talk to your GP, who will be in contact with the surgeon and should be able to tell you what will happen.
You may also find some of the information on our living with vulval cancer section helpful.
