[Diagnosis of vulvar diseases. 2. Discussion and conclusions for practice]

Dystrophic vulvar conditions are found to increase with age and to predominate in postmenopausal women. The differentiation of this entity from infectious lesions and from precancerous conditions by clinical examination is extremely difficult. Therefore, diagnostic procedures are necessary which supplement local inspection and palpation. Photography is useful for documentation and follow-up control and colposcopy is suited for examination of lesions exhibiting erythroplakia, but not for leukoplakia which is much more frequent. Exfoliative cytology occupies a key position in vulvar diagnosis, since negative findings almost rule out a precancerous process, so long as the criteria of malignancy are sufficiently extended to include all abnormalities of the horny cells. Infections frequently cause equivocal cytological findings which disappear after appropriate treatment. Such infections can be diagnosed by phase contrast cytology, cultures, or serological tests. In many cases, further investigation will reveal diabetes mellitus or other metabolic disorders (internal consultant), urinary incontinence (urological consultant), allergic dermatoses (dermatological consultant) or psychoneurotic disease (neurologic consultant). Positive cytological findings always prompt biopsy; but equivocal and negative findings will also lead to histologic examination, if repeated control reveals constancy or exacerbation of a lesion in spite of the use of different diagnostic and therapeutic procedures. Vital staining with the toluidine blue method (so-called Collins test) is well suited for marking para- or dyskeratotic skin areas which then can be removed by surgery.