Normal findings in vulvar examination and vulvoscopy

Authors:
  • NVNine van der Vange
    Nine van der Vange
  • ACAnton J. M. de Craen
    Anton J. M. de Craen
  • JSJan ter Schegget
    Jan ter Schegget
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Abstract
Objective To determine the normal vulvar findings by naked eye examination and by vulvoscopy in healthy women without vulvar complaints.Design Observational study.Population Forty healthy volunteers without vulvar complaints recruited via a newspaper advertisement.Methods Vulvar examination, human papillomavirus (HPV) polymerase chain reaction of vulvar and cervical swabs, saline and KOH smears and vulvoscopy before and after the application of 5% acetic acid.Main outcome measures Prevalence of vestibular erythema, vestibular papillomatosis, HPV infection on the vulva and in the cervix and vulvoscopic findings.Results The mean age of the women was 37.8 years (median 38.0, range 21–56). Nine women were current smokers and 21 had previously smoked. Naked eye vulvar examination showed vestibular papillomatosis in 13 women (33%) and vestibular erythema in 17 women (43%). The touch test was positive in 9 of the 17 women (53%) with vestibular erythema. Vulvoscopy after the application of acetic acid 5% showed an acetowhite vestibule in all women. Twelve women (30%) had acetowhite lesions outside the vestibule. Six women (15%) were positive for HPV DNA. The presence of HPV DNA did not correlate with vestibular erythema or vestibular papillomatosis. There was a weak association between HPV DNA and acetowhite lesions outside the vestibule (P= 0.055, Fisher's exact test). In this group the younger women significantly more often had vestibular papillomatosis (t‐statistic = 3.07; P= 0.003) and women who smoke more often had a genital HPV infection (P= 0.016, Fisher's exact test).Conclusions Vestibular erythema, vestibular papillomatosis, and acetowhite lesions are common in this group of healthy women without vulvar complaints.

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