Author: Dr Estella Janz-Robinson, Resident Medical Officer, ACT Health, Canberra, Australia. Editor in Chief, Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, October 2016.
Vulval (or vulvar) biopsy involves taking a sample of tissue from the vulval skin or muscosal membranes.
Vulval biopsy may be appropriate when:
Typical vulval conditions that undergo biopsy include:
There are no absolute contraindications to vulval biopsy.
Relative contraindications include:
The vulvar skin and mucosa is highly sensitive, and injection with even a small-gauge needle is painful.
To minimise general patient discomfort:
To minimise stinging associated with infiltration of local anaesthetic:
Ensure each specimen is placed in a separate container and correctly labelled with name, date and biopsy site along with a request form prior to transport for processing. Note that although most specimens are transported in 10% formalin as a fixative, direct immune fluorescence and frozen section testing will require fresh specimens.
Any bleeding can be stopped in a variety of ways depending on the nature of the biopsy:
Suture choice includes monofilament nylon (which must be removed 5–7 days after the procedure) and absorbable braided fibre.
Most vulval biopsies are not covered given the difficulty of keeping a dressing in place, however a pantyliner may be useful to protect the area and to absorb any ooze or bleeding.
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