Biopsy of the Vulva

Gross lesions of the vulva often seem to be benign. However, a gross lesion of any description on the external or internal female genitals is suspicious, and with rare exceptions, a biopsy should be taken for histologic analysis.

A histologic specimen encompassing pathologic as well as normal squamous epithelium is obtained from the vulva.

Physiologic Changes: None

Point of Caution: The biopsy should provide reliable pathologic specimens; tangential cutting may lead to misinterpretation.

Technique

The patient is placed in the dorsal lithotomy position. The area of pathologic abnormality is cleansed with antiseptic solution, and the proposed biopsy site is selected.

A Keys punch, commonly used by dermatologists, is excellent for this purpose. The 5-7 mm size allows appropriate pathologic specimens to be taken without leaving a defect large enough to require sutures.

The area is anesthetized with 1 mL of 1% Xylocaine injected subcutaneously. The biopsy is then taken by rotating the Keys punch over the skin in 180° arches.

A delicate forceps is used to elevate one margin of the biopsy, and a small cuticle scissors is used to dissect the biopsy off its bed. A suture is rarely required, and no dressing is applied.

The biopsy is oriented on a piece of saline-soaked gauze, enabling the pathologist to perform ideal sections.

If necessary, a plug can be cut from an Avitene or Gelfoam wafer by using the sharp edge of the Keys punch.

This plug can be placed in the biopsy defect to provide hemostasis. It will act as an excellent dressing for the wound and, in most cases, omit the need for suturing. The patient is instructed to keep the site clean with ordinary soap and water and to wear a perineal pad as required.