Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Nell Suby

Nell Suby, MD

Gyn Oncology

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Sacramento Medical Center
Appt/Advice: 916-614-4055

See all office information »

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Vulvar cancer develops in the skin and tissues around the vaginal opening (vulva). It can:

  • Begin as abnormal (precancer) cells, or as a growth or lump.
  • Affect the inner and outer vulva (labia minora and labia majora) and/or clitoris.

A cancerous (malignant) vulvar tumor can:

  • Damage nearby organs, such as the anus or urethra.
  • Spread to nearby lymph glands. 

Vulvar cancer is often not painful until the tumor is large.

In later stages, cancer cells can enter the bloodstream and spread (metastasize) to other parts of the body.

Human papillomavirus (HPV) is a main risk factor for vulvar cancer. HPV is a common virus. It can be passed from one partner to another during sex.

Treatment options include surgery, chemotherapy, and radiation therapy. 

We can almost always cure vulvar cancer if we catch it early. Together, we’ll create a treatment plan that’s best for you.

Risk Factors

The 2 main factors that can increase your risk of vulvar cancer are:

  • Being exposed to human papillomavirus (HPV) by sexual contact.
  • Growing older. 

Your risk factors may vary depending on your age:

  • In women age 40 to 60 vulvar cancer often begins as precancer. It may be caused by HPV.
  • In women over age 60 vulvar cancer usually begins as a lump in the skin. It often doesn’t have a precancerous phase. It is usually not caused by HPV. 

Vulvar cancer is not passed on by genes you inherit from your family. You cannot catch vulvar cancer from other women who have the disease.

Risks Related to HPV

We know that HPV:

  • Has many variations, most of which are harmless and go away on their own.
  • Has a few variations that can turn into vulvar cancer and a few that can cause genital warts.
  • Is carried, for a few months or years, by most people who have ever had sex. 

Most women who have HPV never get vulvar cancer.

Your risks for HPV and for cervical cancer can be increased by your general health and life choices, including:

  • Having many sexual partners (or having a partner who has had many sexual partners) increases HPV risk.
  • Smoking doubles vulvar cancer risk in women who have HPV. Secondhand smoke exposure may also increase this risk.
  • Having a weakened immune system, due to HIV, chemotherapy, or other conditions, can increase HPV risk.


Often vulvar cancer doesn’t cause symptoms. Some symptoms of vulvar cancer can also be caused by other, less serious conditions.

Call us if you experience any of these:

  • A lump in your vulva, which may or may not be painful.
  • Itching in your vulva that does not go away.
  • Bleeding that is not related to your menstrual periods.
  • Pain or swelling in your vulvar area. 

If you are worried about a growth on your vulva, have it examined by your doctor or nurse practitioner. Most skin abnormalities are not cancerous.

Screening and Diagnosis

There is no screening test for vulvar cancer. Protect yourself by paying attention to your body. Let us know if your vulva doesn’t feel normal to you.

Your doctor or nurse practitioner will do a physical exam. If we find a suspicious area, we may do a biopsy. This means we take a small sample of tissue and have it checked by a laboratory

Our next steps depend on your biopsy results:

  • If you have precancer (vulvar intraepithelial neoplasia, or VIN, also called dysplasia), we’ll talk with you about treatment.
  • If you have cancer, we’ll refer you to a doctor who specializes in treating women’s cancers. 

You may need additional tests to check whether cancer has spread. These include:

  • PET (positron emission tomography) scan.
  • CT (computed tomography) scan. The scanner links to a computer to create a series of detailed X-ray images.

When we catch vulvar cancer early, we can almost always cure it.


The treatments for vulvar cancer are surgery, radiation therapy, and chemotherapy. Our recommendations for you are based on the size of the tumor and cancer spread (stage).

We’ll work with you to create your best treatment plan.

Additional References:

Your Care with Me

If you suspect that you might have cancer of the vulva, your first contact will typically be with your personal gynecologist, who will evaluate your health and symptoms. If specialty care is needed, your personal gynecologist will place a referral for an appointment in my department.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.


Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you call the Appointment and Advice line
  • Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location.
  • The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.
If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening or immunization.  We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time.  Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department.  When the results are ready I will contact you with your results by letter, secure e-mail message, or phone.  In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a pre-operative medical evaluation that will assure that you are properly prepared for your surgery.


Convenient Resources for You

As your specialist, I have a goal to provide high quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages
  • Manage your prescriptions
  • View your past visits and test results
  • View your preventive services to see whether you are due for a routine screening or updated immunization
  • Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love. 
Learn more about your condition
  • Read about causes, symptoms, treatments and procedures
  • Find interactive health tools, videos, and podcasts to help you manage your condition
  • View programs to help you decide on or prepare for a surgery or procedure
Stay healthy
  • Locate health education classes and support groups offered at every medical center
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:


See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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