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Disorders of the vulva and vagina are very common and cause considerable discomfort. Until recently, however, our understanding of vulvar conditions has been scant due to the lack of communication between gynecologists, dermatologists, pathologists, and sex therapists, each with his or her own ideas of the natural history, mode of diagnosis, and preferred therapy. An obvious consequence is the propagation of terms for the same disorders. The establishment in 1970 of the International Society for the Study of Vulvovaginal Disease (ISSVD) fostered exchange of ideas, collective discussion, and understanding of the natural history and modern treatment of vulvar diseases. Common terminology was established. The terminology of benign vulvar and vaginal disorders used in this chapter is based on the guidelines of the ISSVD and the International Federation of Cervical Pathology and Colposcopy (IFCPC). The morphologic and functional approach is accessible to the novice in vulvar and vaginal disease.
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In 2011, the IFCPC introduced a “total” lower genital tract terminology, including the vulva and anus (Table 40–1). The IFCPC vulvar terminology is composed of a clinical part and a colposcopic part. Recognition of patterns of the clinical part can be depicted with a naked eye examination, while those of the colposcopic portion may be determined by using a colposcope, after acetic acid 3–5% application. Once the pattern has been recognized, further evaluation and differential diagnosis may be carried out. There is also a description of abnormal findings of the vulva that characterize each lesion by its size, location, type, color, and secondary morphology, if present. The abnormal colposcopic or other magnification findings encompass the colposcopic recognition of intraepithelial and invasive neoplasia of the vulva, including the anus. The colposcopic examination after the application of acetic acid (vulvoscopy or anoscopy) helps to delineate the lesion and choice of biopsy site.
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