Clinical microscopes have helped physicians and clinicians worldwide in assessing patients and diagnosing diseases. Samples of tissues to test vulvar conditions could be examined with the use of clinical microscopes right at the clinic for fast and reliable results.
Pseudofolliculitis similar to pseudofolliculitis barbae (bumps) may occur in women who shave pubic hair to conform to a bikini. It consists of an inflammatory reaction surrounding an ingrown hair and occurs most commonly among individuals with curly hair, particularly African-Americans.
Fox-Fordyce Disease is characterized by a chronic, pruritus eruption of small papules/cysts formed by keratin-plugged apocrine glands. It is commonly present over the lower abdomen, mons pubis, labia majora, and inner portions of the thighs.
Hidradenitis supp. tiva is a chronic condition involving the apocrine glands with the formation of mulls deep nodules, scars, pits, and sinuses that occur in the axilla, vulva, and perineum. Hyperpigmentation and secondary infection are often seen. Hidradenitis suppurativa can be extremely painful and debilitating. It is often treated with antibiotics (with coverage of both aerobic and anaerobic bacteria) after tissue culture to examine the presence of bacteria using clinical microscopes. Estrogens or antiandrogen therapy has 1 attempted; surgical therapy with wide local excision may be necessary.
Acanthosis nigricans involves widespread velvety pigmentation in skin folds, particularly the axillae, neck, thighs, submammary area, and vulva and surrounding skin. It is of particular interest to gynecologists because of its association with androgen disorders and as such, is associated with obesity, chronic anovulation, acne, glucose intolerance, and diovascular disease.
Intraepithelial Neoplasia
Extramammary Paget’s disease of the vulva is an intraepithelial neoplasia containing vac¬uolated Paget’s cells as seen under clinical microscopes. Clinically, it may have an appearance varying from moist, oozing ulcerations to an eczematoid lesion with scaling and crusting, to a grayish lesion. A biopsy to confirm the diagnosis is mandatory with the use of clinical microscopes.
Vulvar intraepithelial neoplasia is associated with human papillomavirus infection and is increasing in frequency, particularly among young women. Diagnosis requires biopsy of any suspicious vulvar lesions using clinical microscopes, particularly those that are pigmented or discolored. The increasing frequency of this entity makes a careful vulvar inspection mandatory during annual gynecologic examinations.
Vulvar tumors, Cysts and Masses
Condyloma acuminata are very common vulvar lesions and are usually easily recognized and treated with topical therapies such as tri- and bichloroacetic acid. Other sexually trans¬mitted organisms, such as the virus responsible for molluscum contagiosum and the lesions of syphilis and condyloma lata, may occasionally be mistaken for vulvar condyloma acuminata caused by the human papillomavirus. There is argument regarding whether sebac cysts exist on the vulva or whether these lesions are histopathologically epidermal or dermal inclusion cysts. These cysts may result from the burial of fragments of after the trauma of childbirth or episiotomy.
Recently, it has been argued that the commonly cited concept of milk lines extending into the vulva and accounting for lesions of mammary-like anogenital glands (e.g., fibroadenoma, lactating glands) is not supported by observations in human embryos; such show that primordia of the mammary glands do not extend beyond the axillary pectoral area. Eccrine or apocrine glands have been suggested as the probable source of unusual lesions.
A Bartholin duct cyst is a common vulvar lesion. They result from occlusion of the duct with accumulation of mucous and are frequently asymptomatic. Infection of the gland may result in the accumulation of purulent material, with the formation of a rapidly enlarging painful, inflammatory mass (a Bartholin abscess). An inflatable bulb-tipped catheter is quite easy to use. The small catheter is inserted through a small stab wound into the abscess after infiltration of the skin with local anes¬thesia; the balloon of the catheter is inflated with 2-3 cc of saline and the catheter remains in place for 4-6 weeks, allowing epithelialization of a tract and the creation of a permanent gland opening.
Skene duct cysts are cystic dilations of the Skene glands typically located adjacent to the urethral meatus within the vulvar vestible. Although most are small and often asymptomatic, they may enlarge and cause urinary obstruction, requiring excision.
The symptom of painful intercourse (dyspareunia) may be caused by many different vul-vovaginal conditions, including common vaginal infections and vaginismus. A careful sexual history is essential, as is .a careful examination of the vulvar area and vagina. Vulvodynia is the term used to describe unexplained vulvar pain, sexual dysfunc¬tion, and the resultant psychological disability. The term vulvar vestibulitis has been used to describe a situation in which there is pain during intercourse, primarily during en¬try: tender areas surrounding the vulvar vestibule and hymenal ring characterize the condition. A number of recent studies have failed to demonstrate a consistent relationship with any genital infectious organism, including chlamydia, gonorrhea, Trichomonas, mycoplasma, Ureaplasma, Gardnerella, Candida, or human papillomavirus, all visible under a microscope
Other conditions that have been described as contributing to vulvar pain and dyspareunia include subclinical human papillomavirus infection. In cases of vulvar symptoms that have been studied carefully using PCR (polymerase chain reaction) technology, man papillomavirus has not been found to be causative of either the symptoms or the visible lesion of vestibular papillomatosis. Vestibular papillomatosis may be nonspecific response to discharge or inflammation.