Differentiating normal and abnormal findings of the vulva.

Proper evaluation of the vulva required background in general dermatology and an understanding of the special nature of many vulvar conditions. A firm understanding of normal vulvar findings is necessary to guard against overdiagnosis and unnecessary treatment. In the past few years, the most common overdiagnosis has been that of micropapillae of the inner labia minora, or acetowhite changes of the vulva, secondary to human papillomavirus (HPV) infection. Differentiating normal variants and minor nonspecific findings from well-developed disease is not always easy. Vulvar biopsy should be performed if a diagnosis cannot be made confidently by visual inspection alone. Vulvar intraepithelial neoplasia is a precancerous lesion of squamous origin associated with HPV infection. It usually occurs in younger patients. Vulvar intraepithelial neoplasia in older women is associated with chronic inflammation, especially in areas of hyperplasia and atrophy. The older patient with vulvar intraepithelial neoplasia has a higher risk of developing invasive vulvar cancer.