General principles in the diagnosis and treatment of vulvar diseases

There are several major considerations that compel us to regard the vulva in a special way. Its surface epithelium encompasses a range from mucosa, to keratinized glabrous skin, to keratinized, hair-bearing skin. It thus needs to be approached from the point of view of a dermatologist who has an interest in sexually transmitted diseases and mucosal pathology. Dermatologists have long dealt with another mucosal surface, the mouth, and there are numerous similarities between the two--witness several important orogenital syndromes. The vulva serves both sexual and obstetric functions, so disorders in this area naturally fall in the purview of the obstetrician-gynecologist. What we have attempted to do is to put forth a guide for evaluation and treatment of these patients that is essentially a combination of both approaches. In the authors' experience, we have learned a great deal from each other. We have learned to take a history, examine a patient, and eventually treat her with a combination of dermatologic and gynecologic modalities. If the dermatologist reading this article has become familiar with gynecologic techniques, and the gynecologist with dermatologic techniques, and they have learned when to apply each, we have accomplished our aim.