GUIDELINES   

Minerva Obstetrics and Gynecology 2022 December;74(6):471-9

DOI: 10.23736/S2724-606X.22.04944-2

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

SIIV position paper: clinical approach to vulval diseases. Need for quality standards

Carmine CARRIERO ¹ ✉, Pina BELFIORE ², Monica CORAZZA ³, Stefano CRIPPA ⁴, Angelina DE MAGNIS ⁵, Luciano MARIANI ⁶, Leonardo MICHELETTI ⁷, Eleonora P. PRETI ⁸, Mario PRETI ⁷, Gianluigi RADICI ⁷, Camilla SALVINI ⁹, Gianluigi TADDEI ¹⁰, Giulio TOSTI ¹¹, Annarosa VIRGILI ³

¹ Unit of Obstetrics and Gynecology, Department Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy; ² Private Practitioner, Palermo, Italy; ³ Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; ⁴ Bedfordshire Hospitals, Luton & Dunstable University Hospital, Luton, UK; ⁵ Department of Gynecology and Obstetrics, University of Florence, Florence, Italy; ⁶ HPV-Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy; ⁷ Department of Surgical Sciences, University of Turin, Turin, Italy; ⁸ Unit of Preventive Gynecology, European Institute of Oncology IRCCS, Milan, Italy; ⁹ Unit of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy; ¹⁰ Department of Science for Woman and Child Health, University of Florence, Florence, Italy; ¹¹ Division of Melanoma Surgery, Sarcoma and Rare Tumors, European Institute of Oncology IRCCS, Milan, Italy

This paper summarizes the position of the Italian Society of Vulvology on the clinical approach to vulval disease. A thorough history (general medical, gynaecological, and vulval history) is essential for a successful and fruitful vulvological examination. Characteristics of pruritus (itch) and pain, that are the two main vulval symptoms, should be collected and reported with precision, according to duration, temporal course, location, provocation, and intensity. Physical examination must consider both the general condition of the patient and the specific vulval region, that must be examined following a standardized methodology. The physical examination of the vulva is carried out with naked eye and adequate natural or halogen lighting. The subsequent use of instrumental magnification can be considered on particular parts of skin/mucosa, already highlighted with the first inspection. Also, palpation is essential, allowing to appreciate physical features of vulval lesions: consistency, surface, soreness, adherence to underlying plans. Finally, the five-step approach of the International Society for the Study of Vulvo-vaginal Disease about Terminology and Classification of Vulvar Dermatological Disorders (2012) is summarized. A vulval biopsy may be useful in the following situations: when clinical diagnosis is uncertain, lesion not responding to treatment; histologic confirmation for a clinical diagnosis and exclusion or confirmation of a suspected neoplastic intraepithelial or invasive pathology.

KEY WORDS: Vulva; History; Physical examination; Terminology; Biopsy