Ed Everest's Guide to Many of the World's Best English-Language Cancer Websites


The home page address is http.bestcancersites.com

 
Vulvar cancer on the internet - information and support.

I retired from working on my website bestcancersites.com several years ago now but due to continuing involvements with internet friends and colleagues from the years when one of the groups I ran was a Facebook information and support group for those with vulvar cancer, I'm maintaining this page and currently giving it an update.
Ed Everest, April 2017.

This is a summary of the best internet resources for those affected by vulvar cancer that I know about.

Most links on this page open in a new window so to return to this page simply minimise or close the new window.

Vulvar cancer is one of the gynaecologic cancers along with ovarian, cervical, uterine, vaginal, gestational and tubal cancers. Vulvar cancer is also known as vulval cancer and vulva cancer - I will use the word vulvar here.

The National Cancer Institute (USA) defines vulvar cancer as "Cancer of the vulva (the external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina)."

How common is vulvar cancer? On 22nd April 2017 I found that the National Cancer Institute Surveillance, Epidemiology, and End Results Program was giving the following estimate for vulvar cancer for the USA: "Estimated New Cases in 2017 6,020".

The population of the USA was about 325,000,000 (three hundred and twenty five million) at the beginning of 2017 and the population of the world about 7,500,000,000 (seven thousand five hundred million) so a simple extrapolation suggests about 139,000 people would be diagnosed with vulvar cancer worldwide in 2017 if everyone were to have the same access to medical resources in 2017 as those in the USA, and all other things were equal.


One of the best sources of information on vulvar cancer is the website of the USA Government's National Cancer Institute at www.cancer.gov. The section devoted to vulvar cancer gives an easy to read and easy to understand description of what vulvar cancer is, how it is diagnosed, treatment options, descriptions of treatments, and more.

To locate the section on vulvar cancer, go to their home page, find a heading 'Find a Cancer Type' or 'Types of Cancer' (or similar wording) and find Vulvar Cancer in the alphabetical list. Or use their search window to find it. On 22nd April 2017 when I last checked, the vulvar cancer section was titled "Vulvar Cancer—Patient Version" and there's another section titled "Vulvar Cancer Treatment (PDQ®)—Health Professional Version".

The American Cancer Society, a voluntary organisation, runs one of the most comprehensive websites on cancer and cancer-related matters on the net. Their address is www.cancer.org. The layout of their home page changes with moderate frequency so to find their section on vulvar cancer I suggest looking for a heading such as 'types of cancer' or 'learn about cancer' or click on 'Menu', or use their search facility.

The American Cancer Society's website has many other resources too for those involved with cancer so it's well worth browsing their site for additional information and support that may be relevant to your situation.

There is a lively vulva and vagina cancers support and information sharing group called "VULVA & VAGINA Cancers & VIN and VAIN Facebook Group" with about 200 members, run by Elizabeth Plews on Facebook. It's a secret Facebook group and there are instructions on how to join on this Facebook page www.facebook.com/groups/302534469842744/ in the post pinned to the top which starts "Welcome Ladies". Only ladies with vulva or vagina cancer or pre-cancer conditions are accepted into the group and no members of the medical profession are permitted to join.

Here are links to some good sources of information on VIN (vulval intraepithelial neoplasia) that should help in understanding the current thinking on the diagnosis and treatment of VIN:
www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Pre-cancerousconditions/Vin.aspx

www.patient.co.uk/health/Vulval-Intra-epithelial-Neoplasia.htm

www.dermnetnz.org/site-age-specific/vulvar-intraepithelial-neoplasia.html

A few years ago I did a search on the internet for images that show the detailed anatomy of the vulva. I found two really good photos, one of them with labels showing the different parts of the vulva, and I've put them on the following web page, together with another good photo of the female anatomy as seen from directly below www.bestcancersites.com/misc-images-1/index.html.

The images come from Wikimedia Commons http://commons.wikimedia.org "a media file repository making available public domain and freely-licensed educational media content (images, sound and video clips) to everyone ... ". They have been donated to Wikimedia Commons for purposes such as the educational ones we are putting these images to here. They leave nothing to the imagination so please don't go there if it's not your scene. You need to scroll down the page a bit to see the images.

The big United Kingdom website Macmillan Cancer Support at www.macmillan.org.uk has a section on vulvar cancer and its treatment, beginning on this page (when I checked on 21st April 2017) www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Vulvalcancer.aspx. They also run a group called Vulva Cancer which was quite active when I checked on the same day and was located here https://community.macmillan.org.uk/cancer_types/vulva-cancer/f/183/p/126819/1003605.

Many women with a cancer problem also have concerns and questions about hysterectomy. Hystersisters.com at www.hystersisters.com has several forums on hysterectomy including one called ‘Cancer Concerns’. “Hyster Sisters is a women helping women website for hysterectomy support”. When I checked on 19th February 2005 they had 61,424 members, and a total of 176,957 threads and 1,172,544 posts. When I checked on 26th May 2011 they had 228,724 members, and a total of 409,011 threads and 3,404,851 posts. When I checked on 21st April 2017 they had 437,497 members, and a total of 598,370 threads and 4,810,956 posts !

If you want to delve deeper into any aspect of cancer, a good source of information is Medlineplus at www.medlineplus.gov. It's a service of the U.S. National Library of Medicine and the National Institute of Health and it's a big well-organised and easily searchable site. The link to the section on cancers is www.nlm.nih.gov/medlineplus/cancers.html
and the link to their section on vulvar cancer is
http://nlm.nih.gov/medlineplus/vulvarcancer.html.

The human papilloma virus hpv.

The human papilloma virus, commonly known as hpv, is the cause of most cervical cancer cases in women, and can also cause other cancers in the genital and anal area including vaginal, vulvar, penile and anal cancers. Recent research is indicating it's also a common cause of some oropharangeal cancers - cancers of the mouth and throat. The American Cancer Society says "More than half of all vulvar cancers are linked to infection with the high-risk HPV types. HPV linked vulvar cancer is more common in younger women and is seen less often in older women."

Fortunately vaccines have recently been developed that can immunise young people against these high risk infections and they are already reducing the incidence of infections where they have been deployed. They won't cure a cancer visitation you may already have but for those who've not been infected with a high-risk hpv, and for generations yet to be born, these vaccines are a wonderful medical breakthrough.

You'll probably come across information relating to the link between some vulva cancers and hpv on the websites I've given links to above. Below is some fairly detailed information I gathered on some aspects of this subject and if you're still gathering basic information on vulva cancers and their treatments you may wish to visit this section below at a later time.

The Centers for Disease Control and Prevention website http://cdc.gov has some of the best information on hpv I have found anywhere. If you're exploring or researching the subject of hpv and cancers I suggest putting their articles on your list of reading to check out.

Their section on hpv starts on the page https://www.cdc.gov/hpv/parents/cancer.html where you can find links to their various specific articles.

Another good website to explore is hpvinfo.ca at www.hpvinfo.ca - "spread the word not the disease" - it's an educational site administered by the Society of Obstetricians and Gynaecologists of Canada (SOGC).

Here's a a link to an infographic from the Mount Sinai Medical Center website www.mountsinai.org designed to disseminate important information in a sensitive way. You may need to left-click on the infographic to expand it to its correct size.

Research mostly over the past two decades is showing that the human papilloma virus is a common cause of some head and neck cancers (along with tobacco and alcohol), mostly of the kind known as oropharangeal cancers. These are cancers of the back of the tongue and tonsils and the tonsillar pillars and throat. If you would like to explore this subject further, there is very good information on the Oral Cancer Foundation website http://oralcancer.org. I suggest putting hpv into the search window on their home page to find their articles and other items on the topic.

Finding information on more uncommon or rare kinds of vulva cancers can be difficult and below there are sections I prepared on melanoma cancers of the vulva and extramammary paget's disease of the vulva (EMPD). Then there's an short article I wrote called "Who's calling the vulva the vagina and why?". It makes as much sense to call the vulva the vagina as it does to call the mouth the throat, but nevertheless you may be surprised to see who are among the users of this strange kind of euphamism.

Melanoma cancers of the vulva and vagina.

Extramammary Paget's disease of the vulva (EMPD).

Who's calling the vulva the vagina and why?

Using your back button should return you to this location.

Melanoma cancers of the vulva and vagina.

I've searched the internet for information about melanoma of the vulva and vagina. This is a summary of my current understanding of the topic, based solely on what I've found on the internet.

The American Cancer Society on its website says "Around 5 of every 100 melanomas in women occur on the vulva, usually on the labia minora and clitoris. They make up about 6 of every 100 vulvar cancers."

There are two kinds of vulva melanoma (perhaps more but I haven't seen any reference to any others) - cutaneous and mucosal. Both start in pigmented cells called melanocytes.

Cutaneous melanoma of the vulva starts in melanocyte cells in the skin, usually on the outer (large) labia. It's the same kind of melanoma that occurs elsewhere on the skin, the one that is commonly caused by too much exposure to ultraviolet light in sunlight or the ultraviolet light used in tanning beds, and sometimes it's a consequence of inherited genes.

Mucosal melanoma starts in melanocytes in mucosal membranes that line some of the inner parts of the vulva including the inner lips and near the entrance to the vagina. **

Mucosal membranes can contain considerable numbers of melanocyte cells. It's not yet known for sure why melanocyte cells occur in mucosal tissue but they do, and they can give rise to mucosal melanoma in the vulva, vagina, cervix, anus, sinuses, mouth and other parts of the body where mucosal tissues occur.

Cutaneous melanoma is the same kind as the skin cancer melanoma most of us have heard about. The earlier cutaneous melanoma is found and surgically removed, the more chance it won't cause any further problems. If cancer cells have detached from the initial site and moved through the lymph system or blood vessels to another site or sites, often firstly to nearby lymph nodes, it's considerably more difficult to treat.

As far as I know, mucosal melanoma is the only kind of melanoma that occurs in the vagina and in the cervix, and it's even rarer in those places than it is in the vulva.

Mucosal melanoma of the vulva and vagina and cervix is so rare that experts are still developing their understanding of how it develops and evolves and the best ways to treat it. As with cutanoeus melanoma, it seems that surgery to remove it while it's in early stages of development currently offers the best chance of preventing further problems. Because the vagina and the inner parts of the vulva are hidden from view to casual observation, mucosal melanoma is less likely to be discovered early on than is cutaneous melanoma.

Scientists and the medical profession are still at an early stage in their understanding of mucosal melanoma of the vulva and vagina and cervix. There's not much information about it on the internet and it's barely or not mentioned on the biggest and best general cancer websites I've searched.

An article published by Dr. Richard D. Carvajal, "Memorial Sloan-Kettering Cancer Center, New York City", gives the clearest introduction to mucosal melanoma I've found on the internet. I've put a link to his article below. He says among other things:

"Melanoma, regardless of where on the body it occurs, originates from normal pigment cells called melanocytes. These melanocytes produce melanin, the vital pigment which protects the skin from damage caused by the sun's ultraviolet rays. Like any other cell in the body, melanocytes can transform into cancerous cells, and when this transformation occurs, the end result is the development of melanoma. Although normal melanocytes are present in the skin, they are also present elsewhere, such as the mucosal surfaces of the body. These mucosal surfaces line the sinuses, nasal passages, oral cavity, vagina, anus, and other areas. In fact, while there are approximately 800 melanocytes per square millimeter in the skin of the abdomen, there are 1,500 melanocytes per square millimeter present within the mucous membranes of the nose and mouth. Like the melanocytes found in the skin, these mucosal melanocytes can also become cancerous. This transformation results in the development of a type of melanoma called mucosal melanoma."

"Although first described in 1856, mucosal melanoma is not a well-known entity due to its relative rarity. Indeed, of the 69,000 cases of melanoma diagnosed in the United States in 2010, less than 5% were mucosal melanoma. Slightly over half of all mucosal melanomas begin in the head and neck region, approximately one quarter of mucosal melanomas arise from the anorectal region, and another 20% arise from the female urogenital tract. Melanomas originating in mucosal surfaces lining the esophagus, gallbladder, bowel, conjunctiva, urethra, and other sites are far less common."

"While melanoma arising from the skin and mucosal surfaces all originate from melanocytes, cutaneous melanoma and mucosal melanoma differ dramatically in their behavior and underlying biology. The initiation and development of cutaneous melanoma is usually associated with a history of sun exposure, particularly during childhood; however, this association is certainly not the case for mucosal melanoma. Indeed, at this time, no clear predisposing exposures, family history, or other risk factors have been established for this disease."

"As with most cases of melanoma, complete surgical removal of the primary mucosal melanoma provides patients with the greatest likelihood of a cure. ... ".

There is some very interesting and reasonably promising research and some trials going on at present on new ways to treat metastatic melanoma, including looking for ways to encourage the body's immune system to destroy the cancer cells. The most promising aspect of this new research and trials to me is that it's working down at the molecular level where the action really is.

A paper called "Primary mucosal melanomas: a comprehensive review" provides good information and discussion about mucosal melanoma, albeit rather difficult to understand in places. Its address is http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466987/

I quoted above from an article by Dr. Richard D. Carvajal. It's good but it rather emphasises the negative rather than the positives at times, perhaps because its title and chief intent is "A Call to Arms in the Battle against Mucosal Melanoma". Its address is www.susanfazio.org/mucosalmelanoma.html

If you've been diagnosed with melanoma of the vulva or vagina you've joined a pretty exclusive club, and at the same time you've joined another very big club. In the US for example the American Cancer Society says "The American Cancer Society’s estimates for the number of melanoma diagnoses in the United States for 2017 are: "About 87,110 new melanomas will be diagnosed (about 52,170 in men and 34,940 in women)."

If you're looking for a very big community or forum of people who've been diagnosed with melanoma, of any kind anywhere on the body, including the vulva and the vagina, I suggest exploring and maybe joining "MPIP: Melanoma Patients Information Page" at www.melanoma.org/community/mpip-melanoma-patients-information-page. Here's some info they give about the community forum.

"The MPIP is the oldest and largest community of people affected by melanoma hosted through the Melanoma Research Foundation. It is designed to provide support and information to caregivers, patients, family and friends. Once you have been touched by melanoma—either as a patient or as a family member or friend of a patient—you become part of a community. It is not a community anyone joins willingly. But if you must be part of this group, you will find no better place to find the tools you need in your journey with this cancer, and the friends who can make that journey more bearable." "The information on the bulletin board is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies."

I suggest "testing the waters first" if you're new to online cancer-related communities, by reading some of the posts first (or getting a friend to do so).

Extramammary Paget's disease of the vulva (EMPD).

This is a very rare condition of the vulva, and it can also occur elsewhere. I gather that there are only a few hundred cases reported in the scientific literature.

Firstly an important note. On this page I've discussed information and quoted text from some websites, and I recommend that if the information you read is medically important to you or someone you know, please go to the websites and read the relevant sections. There you can read the information in its full context and you'll be sure to read any new information added or changes made since I updated this page in April 2017.

Now to some terminology. Wikipedia says here https://en.wikipedia.org/wiki/Paget's_disease
"Sir James Paget, a surgeon and pathologist, described several diseases, such as:
Paget's disease of bone (most common use of Paget's disease)
Paget's disease of the breast
Paget-Schroetter disease
Extramammary Paget's disease (EMPD)"

These are all separate diseases except that Paget's disease of the breast and Extramammary Paget's disease are apparently very similar and I've seen them referred to as the same disease. Paget's disease of bone and Paget-Schroetter disease don't affect the vulva or vagina so we're not talking about either of those.

The best up-to-date scientific overview of EMPD and its diagnosis and treatment I've seen is one called "Extramammary Paget Disease" here http://emedicine.medscape.com/article/1100397  which was updated on September 30, 2016. There's lots of medical terminology but its pretty brief and may be the most reliable guide to EMPD available, so it's well worth reading through. The above link goes to the introductory page of their section on EMPD. If you scroll down that page you'll find links to individual sections, under the heading "Sections Extramammary Paget Disease". If you have any problems navigating from section to section then you can use that set of links to the different sections.

If the above Medscape website keeps putting an invitation to register on your screen, I registered and it's one of the simplest registrations onto a site I've encountered, and it's free, and really does only take a few minutes unless like me you take about ten minutes to decide on a password.

They say "Extramammary Paget disease (EMPD) is a rare condition; there are only several hundred cases in the world literature."

I can't vouch for the veracity of that figure, but if it's a good ball-park estimate, it means that scientists and the medical profession have only those several hundred cases reported in the scientific literature to try and deduce overall characteristics of the disease, including its causes, the best treatments and follow-ups for it, the extent to which it may be a consequence of cancers elsewhere in the body and if so which cancers, etc. It's not many cases to draw conclusions from or give definitive answers to commonly asked questions about EMPD.

I haven't seen any estimates of the number of people around the world who would currently have EMPD.

So what is Paget's disease of the vulva and where does it fit into the overall picture of vulva cancers?

The Macmillan cancer support website under the heading "Paget’s disease of the vulva" here http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Aboutvulvalcancer/Causes.aspx  says:

"This condition causes abnormal changes in the cells that cover the skin of the vulva. It’s rare and usually only affects women who’ve been through the menopause. In a small number of women with Paget’s disease of the vulva, cancer is found underneath the area."

The American Cancer Society says on its website in their section "What is vulvar cancer" here http://www.cancer.org/cancer/vulvarcancer/detailedguide/vulvar-cancer-what-is-vulvar-cancer under the heading "Types of vulvar cancer":

"Squamous cell carcinomas
Most cancers of the vulva are squamous cell carcinomas. This type of cancer begins in squamous cells, the main type of skin cells. There are several subtypes of squamous cell carcinoma ... [brief description follows]

"Adenocarcinoma Cancer that begins in gland cells is called adenocarcinoma. About 8 of every 100 vulvar cancers are adenocarcinomas. Vulvar adenocarcinomas most often start in cells of the Bartholin glands. These glands are found just inside the opening of the vagina. A Bartholin gland cancer is easily mistaken for a cyst (accumulation of fluid in the gland), so a delay in accurate diagnosis is common. Most Bartholin gland cancers are adenocarcinomas. Adenocarcinomas can also form in the sweat glands of the vulvar skin."

"Paget disease of the vulva is a condition in which adenocarcinoma cells are found in the top layer of the vulvar skin. Up to 25% of patients with vulvar Paget disease also have an invasive vulvar adenocarcinoma (in a Bartholin gland or sweat gland). In the remaining patients, the cancer cells are found only in the skin's top layer and have not grown into the tissues below."

Here's some wording on the National Cancer Institute web site that may help us to understand what Paget's disease of the vulva is. Down near the bottom of this page http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-what-is-anal-cancer  they say under the heading "Invasive anal cancers":
"Adenocarcinomas: A small number of anal cancers are known as adenocarcinomas. These can develop in cells that line the upper part of the anus near the rectum, or in glands located under the anal mucosa that release their secretions into the anal canal. These anal adenocarcinomas, are treated the same way as rectal carcinomas. For more information, see [our document], Colorectal Cancer."

"Adenocarcinomas can also start in apocrine glands (a type of sweat gland of the perianal skin). Paget's disease is a type of apocrine gland carcinoma that spreads through the surface layer of the skin. Paget's disease can affect skin anywhere in the body but most often affects skin of the perianal area, vulva, or breast. This condition should not be confused with Paget’s disease of the bone, which is a different disease."

In the Medscape article I referred to earlier http://emedicine.medscape.com/article/1100397  they say:

"EMPD arises as a primary cutaneous adenocarcinoma in most cases. The epidermis becomes infiltrated with neoplastic cells showing glandular differentiation. Tumor cells may originate from apocrine gland ducts or from keratinocytic stem cells."

"Approximately 25% of the cases of EMPD (range, 9-32%) are associated with an underlying in situ or invasive neoplasm. In all patients, the neoplasm most likely to be associated with EMPD is an adnexal apocrine carcinoma. This associated neoplasm probably represents infiltration of the deeper adnexa by epidermal Paget cells. Other malignancies besides cutaneous adnexal carcinoma that may be associated with EMPD include carcinomas of the Bartholin glands, urethra, bladder, vagina, cervix, endometrium, and prostate."

Now for some information on treatments for EMPD. There appear to be no well-established treatment guidelines yet because of the rarity of the disease. On the American Cancer Society website here http://www.cancer.org/cancer/vulvarcancer/detailedguide/vulvar-cancer-treating-vulvar-adenocinarincoma  they say under the heading "Treatment of vulvar adenocarcinoma":

"If Paget’s disease is present and there is no associated invasive carcinoma, treatment is wide local excision or simple vulvectomy (see “Surgery for vulvar cancer”). If an invasive adenocarcinoma of a Bartholin gland or of vulvar skin sweat glands is present, a partial radical vulvectomy is recommended with removal of inguinal (groin) lymph nodes on one or both sides of the body, depending on the site of the primary tumor."

"Advanced vulvar adenocarcinoma is often treated with chemotherapy or radiation."

In the Medscape review http://emedicine.medscape.com/article/1100397  they say under the heading "Surgical Excision":

"Margin-controlled surgical excision of all the involved epidermis is the most effective treatment. EMPD extends beyond the visibly involved margins. Obviously involved skin should be examined by using transverse frozen sections or serial vertical sections (see Workup). Multiple scouting biopsies performed before surgery may aid in planning a more precise initial excision."

"Multifocal disease is a challenge for any surgical method that relies on contiguous tumor spread for effective margin control—even micrographic surgery. Currently, wide radical excision with 5-cm margins or Mohs micrographic surgery are the recommended excision options. ... ". This discussion of surgical excision options continues with further important text and it's a bit long to quote here.

And elsewhere they say:

"Topical imiquimod is considered a possible treatment option, when surgery is a challenge or contraindicated. However, more studies are needed to confirm the use of topical therapies for patients with extramammary Paget disease (EMPD)." There's some relevant information in their brief section headed "Chemotherapy".

I've seen reports of both successes and failures with topical imiquimod treatment. It can be applied by the patient, and it seems it is most likely to succeed where there is no underlying cancer below the surface EMPD. 

EMPD can also occur in the area around the anus (referred to as the perianal region in the literature). In the medscape review http://emedicine.medscape.com/article/1100397 they say:

"Perianal disease is associated with underlying colorectal carcinoma in 25-35% of cases."

About this section on EMPD:—I researched and wrote this page in 2013 and in April 2017 I visited each link and checked the information and quotes on the page and updated the text above where needed. My search for good sources of information in 2013 was not exhaustive and I haven't conducted further searches since then. I'm not medically trained and I'm not an expert on EMPD - I've gathered information from responsible science-based mainstream medicine sources and posted it here. If you know of any other good sources of information relating to EMPD you think may be suited to this page or you find any broken links or other significant errors, you can let me know by email everest@bestcancersites.com
Ed Everest April 21st 2017.

Who's calling the vulva the vagina and why?

Quote: “The widespread denial of the existence of female external genitalia (and thus of female sexuality, if not female reality) is, to my mind, a subject worthy of serious discourse. I’ve been concerned with raising ‘vulva consciousness’ since the late 1960s, doggedly keeping the topic at the forefront of my mind and pestering my friends to examine their language. I see our culture’s common practice of mislabeling female genitalia as a serious matter indeed. It is true that Americans do not surgically remove the clitoris and the labia, as is practiced on countless girls and women in other cultures. Instead we do the job linguistically—a psychic genital mutilation, if you will. Language can be as powerful and swift as the surgeon’s knife. What is not named does not exist.” — Dr. Harriet Lerner, “And What Do Little Girls Have?” (New Woman, February 1991). Requoted from "Vulva Love" at www.vulva-love.tumblr.com

Here are three examples I've found on the internet to illustrate the frequent misnaming of the vulva as the vagina in the media and elsewhere.

"The Perfect Vagina": an hour-long TV movie documentary: "Lisa Rogers investigates vaginal cosmetic surgery and why more and more women consider this surgical procedure." This film was apparently shown on the BBC (British Broadcasting Commision), and may be a BBC program although I spent half an hour searching for it on the BBC website without success. The film can be viewed on You Tube here www.youtube.com/watch?v=uMJcGcBc2t8. As of 26th April 2017 it's had 2,485,459 views.

Near the beginning, author and presenter Lisa Rogers says: "I decided to make a film about women and their vaginas, because I want to understand why girls would want to cut up their bits". That tells us the film is about vulvas and vulva cosmetic surgery and they are being called vaginas in the film.

"Labiaplasty" - a 7 minute report by Kirsten Drysdale on the the Australian Broadcasting Commission (ABC) television program called "HUNGRY BEAST". The presenter Kirsten Drysdale says at the beginning: "There's one part of the female body that most of us have seen way more often in pictures than we have in real life. But has censorship skewed our idea of what a normal vagina looks like? And could it be contributing to a new trend in cosmetic surgery?" So she's calling the vulva the vagina throughout the report.

The video ends with this comment by Kirsten: "And yer we know that technically the external female genitalia is called the vulva, and that the vagina refers to the inside bit. We just wanted to use common language so that we didn't confuse people. Plus we just like saying vagina. Vagina."

When I looked on the ABC website on 5th February 2013 it said the report was not available for viewing. It can be viewed on You Tube by people living in Australia and perhaps by people living in other countries (I'm not sure about that) here www.youtube.com/watch?v=pK9GtT-khb0. As at 6th March 2013 it had 212,515 views.

At the end of Kirsten's blog on the ABC website relating to this labiaplasty story, she says: "*DISCLAIMER: Yes, I know I should be using the word vulva. The vagina, technically, is the ‘muscular tube leading from the external genitals to the cervix of the uterus’. The vulva refers to the external part (the ‘lips’, clitoris, etc) which is obviously what we are talking about here. However – the term vulva is not used in everyday language to describe the external female genitalia of humans, so for the sake of making the point clear I’ve opted to use the word vagina in this article as it is commonly (though not entirely accurately) used." Her blog entry is here http://www.abc.net.au/tv/hungrybeast/blog/kdrysdale/healing-it-single-crease/index.html

"The Great Wall of Vagina" is a popular and controversial artwork by British sculptor and artist Jamie McCartney. You can read about it and see images of the panels on "The Great Wall of Vagina" website here http://www.greatwallofvagina.co.uk"http://en.wikipedia.org/wiki/Jamie_McCartney.

A Wikipedia article called "Jamie McCartney" http://en.wikipedia.org/wiki/Jamie_McCartney comments: "McCartney’s works often draw on the powerful tools of spectacle and humour – his whimsical titles are not easily forgotten. The “Great Wall of Vagina” grabs the attention, the scale of it then astonishes and draws us in and then before we know it we’ve been educated us as to how women really look. Similarly in the Physical Photography series McCartney gives us a new way of looking at the body. His new collection SKIN DEEP focuses in on notions of beauty, our personal and societal experience of it and obsession with it, putting us as well as his models under the microscope. The show also features other sculptural works which range from pure aesthetic to pure whimsy, demonstrating the huge range of this dedicated and cerebral British talent as he tackles the most persistent and prevalent subject in art.

The Great Wall of Vagina is of great socio-political importance and is a highly provocative response to the exponential rise in cosmetic labial surgeries. By confronting the viewer and revealing the diversity of female genital appearance, McCartney opposes any notion of a singularly “perfect” aesthetic, thereby forcing society to rethink its relationship with the vulva. Comprising 400 plaster casts of women’s genitals arranged in ten panels, the polyptych spans nine meters in length. McCartney succeeded in reaching a broad demographic, with volunteers coming from all walks of life and ranging from 18 to 76 years of age. Casts of mothers and daughters, identical twins, transgendered men and women all feature; so too do those of a pre and post-natal woman, as well as, rather provocatively, a woman before and after labiaplasty. In creating this work, McCartney set out to alleviate the needless anxiety that is driving so many women to contemplate surgery. His accompanying book includes many moving testimonies of women who took part: these accounts speak of individual empowerment and a sense of liberation that is echoed by those who experience his work."

Does it matter if he's called his artwork "The Great Wall of Vagina" instead of "The Great Wall of Vulva". My personal view is that it does matter, because he's strengthening the misconception that the vulva is called the vagina, and that it's okay to call the vulva the vagina. But this misnaming of the female external genitalia doesn't detract much from the values of the artwork. I would guess that in it's first ten years of existence the Great Wall of Vagina will be viewed by over a hundred thousand people in Great Britain and will be seen or heard about in one form or another on TV, radio, the internet and in books and magazines, and who knows where else, by millions more. This artwork may do more to educate the public in the United Kingdom about the diversity of the human vulva and about feeling confortable talking about vulvas, than just about anything else.


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