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Miscellaneous: Oral Abstract: Chronic vulval problems: A gynaecologist's perspective
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Introduction:
Chronic vulval symptoms are common complaints in women seeking health care and can significantly interfere with a woman's sexual function and sense of well being. Many practitioners feel diagnostically challenged, particularly by chronic or recurrent forms of vulval disease. The aim of this study was to assess the role of various diagnostic modalities in evaluation of chronic vulval symptoms.
Methods:
Between August 2012 and February 2014, 100 women presenting with chronic vulval symptoms (i.e. ≥ 3 months duration) were evaluated. All of them had a thorough clinical history taken including use of vulval washes and creams, a general and gynaecological examination. Patients having chronic vaginal discharge in addition had urethral, vaginal and cervical smear and culture. All women had a careful examination of the vulva with and without magnification. Vulval scrape cytology was taken after moistening the vulva with normal saline and stained by Pap stain. Colposcopy of the vulva was then carried out after applying 5% acetic acid and 1% toluidine blue dye. Vulval biopsy was taken from suspicious areas on colposcopy and further management was based on histopathology report.
Results:
The mean age of women in our study was 43.57 years (range 22-80 years.), 70% women were pre-menopausal and 30% were post-menopausal. The mean duration of symptoms was 1.625 years (range 6 months - 15 years) and atypical vulval hygiene practices (excessive washing with soaps) was used in 77% of women. The commonest presenting complaint was pruritus in 92% of women; visible lesions on vulva were seen in 20%, pain in 6% and burning sensation in vulva in 5% of women. The histopathology was abnormal in 77 patients; the most common histopathological finding was non-neoplastic epithelial disorders in 64 women {Squamous cell hyperplasia (n=52), Lichen Sclerosus et atrophicus (n=6), other dermatoses including lichen Planus (n=6)}. Vulvar Intra-epithelial Neoplasia (VIN) was seen in 6 patients, 5 were squamous type VIN and 1 was non-squamous type (Paget's disease). Squamous cell carcinoma was seen in 3 patients; malignant melanoma, benign appendiceal tumor, angiofibroma and neurofibroma in 1 patient. Examination without magnification had sensitivity of 25.97% and with magnification was 29.87% and specificity was 100% for both of them. Cytology had sensitivity and specificity of 75.32% and 86.95% respectively and sensitivity and specificity of colposcopy was 77.92% and 17.39% respectively.
Conclusion:
Clinical examination with and without magnification had low sensitivity but were highly specific in diagnosing vulvar lesions. A normal vulval smear and colposcopy have a high negative predictive value and are very reassuring. Colposcopy and biopsy is the gold standard for diagnosis, however clinical examination with naked eyes and magnifying glass are invaluable and can diagnose most of the neoplastic lesions.
