Evaluation of vulvar symptoms and examination of patients for vulvar disease and neoplasia constitutea significant part of healthcare for women. Themajor symptoms of vulvar disease are pruritus, burning, non-specific irritation, and/or appreciation of a mass. The vulvarregion is particularly sensitive to irritants, more so than other regions of the body. It has been suggested that the layer overlying the vulva—the stratum corneum—may be less of a barrier to irritants, thereby making the vulva more susceptible to irritations and contributing to the “itch-scratch” cycle. Noninflammatory vulvar pathology is found in women of all ages, but is especially significant in perimenopausal and postmenopausal women because of concern regarding the possibility of vulvar neoplasia.
Diagnostic aids for the assessment of noninflammatory conditions are relatively limited in number and include careful history, inspection, and biopsy. Because vulvar lesionsare often difficult to diagnose, use of vulvar biopsy is central to good care. Punch biopsiesof vulvar abnormalities are most help-ful to determine if cancer is present or to histologically determine the specific cause of a perceived abnormality of the vulva. Cytologic evaluation of the vulva is of limited value, as the vulvar skin is keratinized and epithelium shedding does not occur as readily as that of the cervix. Colposcopy is useful for evaluating known vulvar atypiaand intraepithelial neoplasia.