Which of the following is not a risk factor for vulvar cancer?

Multiparity, which refers to having given birth multiple times, is generally not recognized as a specific risk factor for vulvar cancer. The primary risk factors identified for this type of cancer include the presence of high-risk types of human papillomavirus (HPV) infection, which is strongly associated with the development of various anogenital cancers, including vulvar cancer. Additionally, lichen sclerosus, a chronic inflammatory condition that affects the vulvar skin, has been shown to have an association with an increased risk of vulvar cancer due to the changes it causes in the vulvar tissue over time.

Cigarette smoking also contributes to various forms of cancer, including those of the anogenital region, and has been identified as a risk factor for vulvar cancer due to the carcinogenic substances in tobacco. Therefore, while multiparity does not carry a direct association with vulvar cancer risk, the other factors listed have well-established correlations with the disease.