VIN in pregnancy, normal delivery or C section?

[snix]

Hi Everyone. Have so far been a lurker but plucked up the courage to post after frightening midwife appointment yesterday. I'm nearly 37 weeks pregnant with our 1st and have VIN. (like CIN but on the vulva rather than cervix) It was quite bad during 1st trimester, calmed down during 2nd but has come back with a vengeance these last few weeks. I mentioned this yesterday and the midwife has booked me in with an obstetrician next week but couldn't really give me any info as to what this means in regard to delivery....C section maybe? Has anyone suffered with this and had a normal delivery or does anyone know anyone who has had this or just maybe give me some advice please?
Many thanks in advance.

what's VIN? Sorry if I'm being really thick!

It's basically abnormal cells on the vulva, has 3 stages like CIN does the 3rd 1 being carcinoma in situ.

Oh ok - sorry can't help with your question but I hope the birth goes well.

Thanks Luciemule.
Any thoughts or advice anyone?

Have you seen this page from the Vulval Pain Society? There doesn't seem to be much information about mode of delivery with VIN; my opinion would be that in the absence of evidence that a c/s would be the best option, there's no reason not to plan a vaginal birth, and do whatever you can to boost and support your immune system in the few weeks you have left before birth.

I gave birth with as yet undiagnosed cervical cancer (not just CIN), and there was no suggestion that I had done any further damage by doing so (was worried that I might have spread cancerous cells around!)....tbh I doubt that you'll find any conclusive evidence for birthing one way or the other, so it really comes down to which option you feel is the best. What are your symptoms, do you feel they'd be exacerbated by vaginal birth? And if so, would that be worse than the definite injuries you'd have with a c/s birth? What do you feel you want to do?

Hi Slacker. Thanks for your reply.
So Sorry to hear about your cervical cancer, how are you doing now?
I had seen the page that you linked to...have been googling all morning, but thankyou for taking the time to post it. Symptoms are basically an overgrowth of vulval tissue with hardened areas, a little like hard skin (sorry for the tmi!) Whats concerning me is the old biopsy sites (there are quite a few) The areas which I have had biopsies taken from previously now have thickened scar tissue which to be honest are giving me more pain than any new areas are years after. What's worrying me is failure of those areas to stretch with a vaginal birth, which would result in them splitting, needing stitches, and the scar tissue that would occur due to this. When I spoke to my midwife I was sad at the thought of maybe having a c-section but am now thinking that the long term damage that could occur as a result of a vaginal birth would be worse.
I don't know how to work out what to do for the best, want someone to make the descision for me, which is a cop out I know.
Thanks again Slacker. x

I can really sympathise with you wanting someone else to tell you what to do for the best! My cancer experience was several years ago, I spent months researching and getting second opinions trying to find support for doing what my instincts were telling me (doctors were advising hysterectomy or at least radical removal of my cervix, my instincts said that the large cone biopsy I'd had was enough...I was right!). But I never did find a doctor who could definitively say "this is what you should do in this situation" that I agreed with! It was a real personal growth experience for me, learning that I was the only one who could take responsibility for decisions about my body. Glad I made the right call as I've had another baby since then and am now 30 weeks pg with yet another!

Anyway, your situation is quite complex - you just don't know how a vaginal birth will go and whether more damage will be caused than with a c/s. Do you think there's anything you could do to soften the scar tissue prior to birth? Anything from oil to medication of some sort? I guess the effects of a c/s seem more predictable, but there are unknown risks there too, from wound infection to adhesions to who knows what?

It's certainly possible that even if your scarred skin did split during birth that it would heal well without stitches (e.g. torn perineums heal well within days unless the muscle is torn, salt water works wonders) and there wouldn't really be long term effects, but it's not predictable, maybe a water birth would help as it helps the tissues soften...

As you can tell I'm a bit of a natural birth fan so don't let me tell you what to do, I'm just concerned that c/s seems like the 'safe' option but actually there doesn't seem to be any literature that suggests c/s in this situation, and in general vaginal birth is better for both you and baby. I hope you can get some sensible advice from a professional (although I wouldn't hold my breath if I were you, I had some ridiculous advice from a top London gyn with my situation!) but at the end of the day you just have to go with whichever set of risks you are more comfortable with.

God I've rambled on, hope this is some help to you and you make a decision that you are happy with, it doesn't matter what other people tell you you should do.

xx

Hi again. Sorry I didn't reply sooner, had to shoot off out yesterday.
Well done you for sticking to your guns re. the hysterectomy. That was so obviously the right decision. Congratulations on your pregnancy by the way.
I had a cone biopsy 11 years ago and I thought that I wouldn't be able to carry full term without a cervical stitch.Had an internal scan at 20 weeks and although my cevix was classed as being on the short side (2.4cm) there was no funneling and it was still within normal range. I was elated, didn't think this was gonna be an issue at this late stage. The weird thing is, we were trying to conceive for 9 years, I had various ops and my left fallopian tube removed and a failed ivf cycle and we had decided to have a year out to "be married" again. We were just discussing getting the ball rolling on another ivf cycle when we found out I was pregnant....a miracle in our eyes, had some bleeding early on (10 weeks) and thought our dream was over, but our little fighter pulled through and since then it's been pretty much plain sailing....can't believe this has happened so late in the day, but am so thankful to be here.
I really want a natural birth aside from anything else I don't want to be stuck in hospital for days and after discussing it with DH last night have decided to try and go for that. I have lived with the scar tissue I have for a number of years and while being painful it's do-able if you see what I mean, I can cope with a few more scars if I have to. In fact when I think about things logically it's such a small price to pay for the huge reward of having our own baby. Am going to ask the obstetrician about any oil or cream I could use to try and soften the area. Thanks for that suggestion. xx
I want to say a huge Thankyou Slacker for taking the time to post to me the way you did, you'll never know how much you've helped me get things into perspective. I wish you all the very best for your pregnancy and beyond. Thankyou again. Love Snix xx

OMG you've really been through it haven't you? HPV is such a horrible thing when it gets out of control, I remember learning about HPV (having never heard of it before) and being so upset that I'd acquired it in the first place, but then it became clearer that it was more a failure of my immune system to deal with it well that was the problem, so I made changes to my diet etc to help my body deal with it more effectively, and in that sense it was a positive thing for me! It did flare up again after my last pregnancy (had a colposcopy and could see my previously clear cervix looking quite bad again) but it then went again and I've been 'clear' since.

I'm glad you feel I've helped you reach a decision you're happy with. Now I would urge you to consider how you can best achieve a vaginal birth with the minimum of trauma to your vulva/perineum, which IMHO would be a waterbirth/homebirth i.e. as non-medicalised as possible. (Not that you can't have a natural hospital birth, it's just more difficult). And also do whatever you can to support your immune system and help your body heal itself, a good diet, herbal/sitz baths after birth if you do have trauma to that area, just look after yourself really well. And it sounds like your DH is supportive as well so he can look after you too!

All good wishes to you and I hope that you have a lovely birth, I'll look out for your birth announcement!

Thankyou again Slacker. Will be keeping my eye out for your announcement too. xxxx

Hello

I know this thread has been up for a long while but I wondered how things went? I'm 38 and also have vin and I'm trying to find out what to expect because of it (if I'm lucky enough to fall pregnant) - any advice would be really appreciated.