VULVOSCOPY

A vulvoscopy is a medical procedure during which the vulva (the external part of the female genitalia) is examined using a magnifying device called a colposcope. This detailed examination helps in detecting abnormalities or diseases that might not be visible to the naked eye.

Your GP might refer you for a vulvoscopy if you:

• Are experiencing symptoms including persistent itch, pain or discomfort in the area
• Have visible lesions, sores or unusual growths
• Have an abnormal test result
• Have a known vulval condition requiring regular follow up examinations

A vulvoscopy is typically completed within ten to fifteen minutes. It involves:

• Positioning - During a vulvoscopy, the woman’s legs are placed in leg supports. These can be adjusted to minimise discomfort.
• General examination - The vulval area is usually inspected first
• Use of the colposcope - This device provides a magnified view of the vulval area but does not touch the woman
• Application of acetic acid (vinegar) - This solution can help highlight abnormal areas by causing them to turn white
• Detailed inspection - The area will be re-examined following application of the acetic acid to inspect for any abnormalities or tissue changes
• Biopsy - This is only performed if needed

Most biopsies are performed in the outpatient setting at the time of the vulvoscopy. In some cases, biopsies may be performed under general anaesthetic (for example, if another procedure requiring a general anaesthetic is required as well, if the lesion is located over a sensitive area, if the examination cannot be tolerated or if the affected area is extensive).

A biopsy involves:

• Cleaning the area
• Local anaesthetic- A small needle is used to inject numbing medication to the area
• Prick test- The area is tested to ensure that it is numb before proceeding with the biopsy
• Biopsy- A 3-4 mm area of tissue is taken from the affected area and sent to the laboratory for further testing
• Bleeding is controlled with a suture or silver nitrate

A biopsy may be needed if abnormalities are present on examination to:

• Diagnose infections, skin conditions, precancerous or cancerous changes
• Guide treatment based on the biopsy results

A vulvoscopy is generally well-tolerated and causes minimal discomfort. Mild irritation may be experienced when the acetic acid is applied, but this is usually temporary.

If a biopsy is required, this may cause mild discomfort or cramping but this is usually brief.

It is important to disclose any prior negative experiences prior to the procedure so that additional options for pain relief can be discussed as appropriate. These may include methoxyflurane or organising the procedure under general anaesthetic.

A vulvoscopy can be performed even while taking medications. If a biopsy is required, women taking blood thinners may experience slightly increased bleeding.

Most women can return to work or normal activities immediately after their vulvoscopy.

Some women experience mild cramping, especially if a biopsy is required. This typically resolves quickly, however paracetamol and/or ibuprofen may be required.

Small amounts or bleeding may be present for a few days if a biopsy has been taken. A silver, black or brown discharge may be noted from medication used to stop bleeding at the time of the procedure.

If suturing has been performed, the sutures will typically fall out within two weeks. It is important to keep the area clean by washing the area with water and patting it dry. It is best to avoid tampons, engage in intercourse, swim or take baths/use spas until the area has healed.

The results from biopsies will typically be available within two weeks and this will guide decisions regarding treatment and the need for further follow up.

Complications from a vulvoscopy and/or biopsy are uncommon but can include:

• Bleeding from the biopsy site- This can be self-managed by applying continuous pressure to the area with a clean cloth for five minutes.
• Infection- Pain, swelling, discharge, odour or fever may be experienced. On occasion, stitches can come apart, exposing the underlying tissue.

It is important to get in touch with Dr. Nagubandi if you experience the above symptoms.