Normal findings in vulvar examination and vulvoscopy

Abstract

Objective To determine the normal vulvar findings by naked eye examination and by vulvoscopy in Design Observational study. Population Forty healthy volunteers without vulvar complaints recruited via a newspaper advertisement.Methods Vulvar examination, human papillomavirus (HPV) polymerase chain reaction of vulvar and cervical swabs, saline and KOH smears and vulvoscopy before and after the application of 5% acetic acid. Main outcome measuresPrevalence of vestibular erythema, vestibular papillomatosis, HPV infection on the vulva and in the cervix and vulvoscopic findings. ResultsThe mean age of the women was 37.8 years (median 38.0, range 21-56). Nine women were current smokers and 2 1 had previously smoked. Naked eye vulvar examination showed vestibular papillomatosis in 13 women (33%) and vestibular erythema in 17 women (43%). The touch test was positive in 9 of the 17 women (53%) with vestibular erythema. Vulvoscopy after the application of acetic acid 5% showed an acetowhite vestibule in all women. Twelve women (30%) had acetowhite lesions outside the vestibule. Six women (15%) were positive for HPV DNA. The presence of HPV DNA did not correlate with vestibular erythema or vestibular papillomatosis. There was a weak association between HPV DNA and acetowhite lesions outside the vestibule ( P = 0.055, Fisher's exact test). In this group the younger women significantly more often had vestibular papillomatosis (t-statistic = 3.07; P = 0.003) and women who smoke more often had a genital HPV infection ( P = 0.016, Fisher's exact test).Conclusions Vestibular erythema, vestibular papillomatosis, and acetowhite lesions are common in this group of healthy women without vulvar complaints.healthy women without vulvar complaints. and has been used in the management of vulvar intraepithelial neoplasia (VIN) to remove all visible lesions8-l0. The colposcope was introduced in the evaluation of abnormal cervical cytology because the colposcopic image has been proven reliable in the prediction of histological alterationsll. Although the classification of vulvoscopically visible lesions is the same as the one used for colpo~copy'~, it is uncertain whether vulvoscopy has the same predictive value as colposcopy. This is mainly because the normal distribution of vulvoscopic findings has not been determined in women without vulvar complaints and therefore one cannot distinguish between physiology and pathology. INTRODUCTIONThe aim of this study was to determine the normal vulvar findings by naked eye examination and by vulvoscopy in healthy women without vulvar complaints to obtain a reference value for vulvar examination 320 0 RCOG 1997 British Journal of Obstetrics and Gynaecologyand vulvoscopy in the diagnostic work-up of women with vulvar complaints. METHODSVolunteers were recruited via an advertisement in a national newspaper. They were eligible if they were between 20 and 60 years old, if they were healthy and if they did not have vulvar pruritus, vulvodynia, dyspareunia or known vulvar abnormalities. The approval for this...

Squamous Vulvar Intraepithelial Neoplasia

“…21 Colposcopy of the vulva (also described as vulvoscopy) with the application of 3% to 5% acetic acid is nonmandatory for the diagnosis of VIN usual type and sometimes it gives confounding results. Acetic acid reactivity is a common finding in healthy women without vulvar complaints, 22 and its use can be misleading in nonexperienced hands. Furthermore, the vascular pattern of abnormal vessels is not commonly seen on the vulvar skin.…”

Clinical Scoring System to Detect Malignant and Premalignant Vulval Lesions

“…The presence of acetowhite area after application of 5 % acetic acid was not significantly associated with premalignant lesion in our study as opposed to cases of cervical premalignant lesion. Also, acetowhite changes in the vestibular and vulval areas have been documented to be normal vulval finding previously [8].…”

2011 Terminology of the Vulva of the International Federation for Cervical Pathology and Colposcopy

“…Moreover, many colposcopists, as part of evaluating patients with cervical intraepithelial lesions, look for VIN, perianal intraepithelial neoplasia (PAIN), or AIN [9Y11]. The term vulvoscopy is in widespread use and refers to an examination of the vulva by a colposcope [12]. Several texts and articles on the use of vulvoscopy to diagnose vulvar lesions have been published [13Y16].…”