A classification of vulvoscopic findings for clinical diagnosis

We describe vulvoscopic findings, their correspondence with certain pathological processes, and the grouping of vulvoscopic findings to facilitate clinical practice.

We performed vulvoscopy on 2,352 patients and described what we saw. We then classified the images by groups, according to the diagnoses suggested. Finally, we compared the frequency of the different images as a function of the symptoms, the clinical and histological diagnoses, the history of cervical lesions (cervical human papillomavirus, cervical intraepithelial neoplasia, or cervical carcinoma), and the microbiological studies.

We found 2.33% human papillomavirus-vulvar intraepithelial neoplasia (HPV-VIN) type 1 lesions, 0.52% herpes simplex lesions, and 0.08% VIN2 lesions in asymptomatic patients without a history of cervical lesions. In 95% of patients in whom raised acetowhite patches were found on the skin, vaginal exudate revealed Candida species. The images showing cobbled mucosa and white and red punctation primarily suggested a nonviral infection, though a small percentage of cases were of viral origin. The history of cervical lesions was significant (p < .000001) in the HPV-VIN1 lesion group. For the diagnosis of more severe vulvar lesions (VIN3 and vulvar carcinoma), we found that the joint presence of pruritus and a history of cervical lesions was significant (p < .004).

Vulvoscopy performed as a routine examination procedure enables the detection of some disorders in asymptomatic patients who lack a history of cervical lesions and precludes the need for histological studies in some cases, though in others the image is inconclusive and a biopsy is required. Given that a description of normal findings is available, we are able to eliminate suspect pathological processes through a vulvoscopic examination. The proposed classification can serve as a guide to diagnosis and therapy.