Stigma surrounding HPV (human papillomavirus) – a virus transmitted primarily sexually, but also through skin-to-skin contact – still keeps many families away from vaccination and patients from doctors’ offices, experts warn. Resistance is concerning because HPV is the leading cause of vulvar and vaginal cancer, which resulted in 597 deaths in the Unified Health System (SUS) between January and September 2025.
During the same period, according to the Ministry of Health, 16,559 outpatient visits and 2,161 tumor-related hospitalizations were recorded. The numbers are for procedures, not people, and there is no data on diagnoses. Despite the results, stigma still causes many people to stop seeking help.
For Caetano da Silva Cardial, oncologist at Febrasgo (Brazilian Federation of Associations of Gynecology and Obstetrics), “each tumor linked to HPV carries a significant prejudice”. According to the WHO (World Health Organization), 4.5% of all cancers worldwide (630,000 new cases of cancer per year) are attributable to the virus.
Between 2022 and September 2025, 1,964 deaths from vulvar cancer were recorded in Brazil. The South has the highest rates, with 400 deaths, while the North has 75. São Paulo leads among the states, with 521 deaths. According to Cardial, part of the gap may reflect the flow of patients seeking treatment in more structured regions.
During the same period, the country recorded 593 vaginal cancer deaths, including 147 in 2025 through September. The South-East region concentrates most of the deaths.
Although they are often confused, the vulva is the external part of the female genitalia, made up of skin and hair, while the vagina is an internal lining that connects the vulva to the cervix. According to Cardial, there is confusion between the terms that is common not only in Brazil, but around the world.
Vulvar cancer is considered a rare skin tumor and has two main origins: HPV, more common in women between the ages of 45 and 55, and an autoimmune disease called lichen sclerosus, which generally affects preadolescent and postmenopausal women, peaking after age 60.
Lichen sclerosus does not have a single defined cause, but experts point out that it is mainly linked to an autoimmune mechanism, when the immune system begins to attack the skin itself. Hormonal factors (such as low estrogen levels), genetic predisposition, and repeated trauma to the area can also contribute to the onset of the condition.
The disease causes persistent itching and, without treatment, can progress to cancer in up to 60% of cases, specifies the oncologist. With monitoring and use of corticosteroid ointments, the risk significantly decreases.
Symptoms of the disease are usually nonspecific: itching, sores, ulcers, bleeding, or change in skin color in the area. Because these complaints are common with other conditions, many women delay seeking care. The signs are also confused with those of the tumor, which tend to appear in the most advanced stages of cancer.
When identified early, with tumors smaller than 2 cm and without involved lymph nodes, the chances of curing vulvar cancer are high with surgery. In advanced stages, when there are already metastases, treatment includes radiotherapy and chemotherapy, and the cure rate is reduced.
Vaginal cancer is even less common, with around 500 cases per year in Brazil, and is caused by HPV in 90% of cases, says Cardial. It most often occurs between the ages of 40 and 50, while precursor lesions can appear as early as 30 years old.
Since the vagina is an organ with wrinkles and folds, injuries can be “hidden.” Many women remain asymptomatic until the tumor grows, when internal nodules, pain or bleeding may appear during sexual intercourse, in addition to bleeding outside the menstrual period.
Tumors smaller than 2 cm and limited to the mucosa can be cured by surgery. Deeper or larger tumors generally require radiotherapy combined with chemotherapy.
The specialist explains that as women are younger, the impact on fertility and sex life is generally greater than in the case of vulvar cancer. Radiation therapy can reduce ovarian function, cause dryness, atrophy and even vaginal stenosis (narrowing or shortening of the vaginal canal), if the patient does not maintain sexual activity or use mold during treatment.
Whether it is vulvar cancer or vaginal cancer, early diagnosis is decisive. The doctor emphasizes that women, especially postmenopausal women, should seek treatment if they have persistent itching for more than two weeks, sores, abnormal bleeding or visible changes in the vulva.
Rosana Richtmann, infectious disease specialist at the Delboni Salomão Zoppi e Lavoisier laboratory, emphasizes that Brazil has made progress in screening for both cancers by including molecular tests for HPV in the public network.
“They are much more sensitive than the Pap test (a test used to identify lesions of the cervix, such as those caused by HPV). The goal is to detect the virus early to prevent the lesions from progressing to cancer.”
The HPV vaccine is the main prevention for vulvar and vaginal cancer
Richtmann says vaccination is the best way to prevent vulvar and vaginal cancer. According to her, the younger you are, the better the immune response and the less likely you are to have already been in contact with the virus. The quadrivalent vaccine, offered on the public network, protects against types 6, 11, 16 and 18. The nonavalent version, available on the private network, broadens this coverage.
Experts point out that many families still avoid vaccinating their children because they wrongly believe that vaccination could encourage the start of sex life. For the doctor, stigma also means that young people, when they notice something different in their intimate area, are ashamed to tell their parents or consult a doctor.
The Public Health project benefits from the support of Umane, a civil association which aims to support initiatives aimed at promoting health.
About The Author
