Evaluation of Vulvar Disorders by Vulvoscopy Index and N-S-P Scheme Using Three Rings Vulvoscopy (TRIV)

TRIV is a new and promising technique based on the fact that Vulva can be divided into three circular zones based on anatomy, embryology, and histology- Outer, Middle, and Inner ring. The Vulvoscopy Index and N-S-P scheme are objective tools to improve the systematization of vulvoscopy findings and to simplify information management using TRIV.

Hundred women with vulvar complaints (Cases) and 100 asymptomatic women (Controls) underwent TRIV and findings were documented as per N-S-P Scheme and Vulvoscopy Index. Biopsy was taken from specific lesions. Vulvar disorders were categorized into 5 categories based on histology and clinical findings-Vulvodynia, Impaired vulvar skin, Vulvar dermatosis, pre-malignant lesions of the vulva, and others.

According to N-S-P scheme most common formulas were- N-N-N for Normal vulva, P-P-P for vulvar dermatoses, and N-S-N for Impaired Vulvar skin. The mean Vulvoscopy index was 4.33 ± 0.52 for Impaired vulvar skin, 6.11 ± 2.87 for vulvodynia, 24 ± 6.04 for pre-malignant lesions of vulva, and 25.17 ± 4.31 for vulvar dermatosis. The sensitivity, specificity, and diagnostic accuracy of the Vulvoscopy Index for detecting vulvar disorders were 100%, 96.51%, and 98.50%, respectively. The positive and negative predictive values were 0.97 and 1.00, respectively.

The Vulvoscopy Index is a significant predictor for vulvar disorders. N-S-P scheme helps in the objective and systematic documentation of TRIV findings, which allows monitoring of the vulvar changes. TRIV can be used for preventing early stages of vulvar dermatosis which is a risk factor for vulvar malignancy.