27%. Human Papilloma Virus (HPV) Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with some gynecologic cancers, including those of the cervix, vagina, and vulva. A clear link between human papilloma virus and cervical cancer has long been established, with HPV associated with 70% to 90% of cases. Persistent human papilloma virus infections have been shown to be a driving factor for 70% to 75% of vaginal and vulvar cancers. Smoking Smoking has been found to be a risk factor for the development of cervical, vulvar and vaginal cancer. Current women smokers are twice as likely to develop cervical cancer compared to their non-smokers counterparts. Several mechanisms have been researched to understand how smoking plays a role in the development of cervical cancer. The cervical epithelium's DNA has been shown to be damaged due to smoking. DNA damage levels in the cervix cells were higher in smokers when compared to non-smokers. It has also been postulated that smoking can lower the immune response to HPV as well as amplify the HPV-infection in the cervix. Through similar mechanisms, women smokers have also been found to be 3 times more likely to develop vulvar cancer. Smoking has also been associated with an elevated risk for vaginal cancer. Woman smokers are at double the risk for developing vaginal cancer when compared to women non-smokers. Infertility Infertility is a common disease affecting young adults. Some studies have shown that 1 in every 7 couples will fail to conceive due to infertility problems. Infertility is a known risk factor for gynecologic cancers. Infertile women are at a higher risk of developing ovarian cancer and endometrial cancer when compared to fertile women. Signs and symptoms Signs and symptoms usually vary depending on the type of cancer. The most common symptoms across all gynecological cancers are abnormal vaginal bleeding, vaginal discharge, pelvic pain and urination difficulties. Ovarian cancer Bloating or abdominal swelling Frequent urination Pelvic or back pain Increased satiety/loss of appetite Altered bowel movements Fatigue Weight loss Endometrial cancer Post-menopausal bleeding Abnormal vaginal bleeding (heavy or irregular menstrual cycles) Vaginal discharge Difficulty urinating Pelvic pain Vaginal cancer Abnormal vaginal bleeding Vaginal discharge Pelvic Pain Painful and frequent urination Cervical cancer Abdominal pain Foul-smelling vaginal discharge Pelvic pain and/or back pain Blood spotting Post-menopausal bleeding Vulvar cancer Pruritus: persistent itch in the vulva Vulvar bleeding Vulvar pain, soreness or tenderness Burning