146 Standardization of Vulvoscopy: A Step-Wise Approach

Abstract

In the medical evaluation of a woman with sexual dysfunction, there is no standard methodology for physical examination. The purpose of this was to develop a standardized technique of magnified examination of the vulvar, vestibular and vaginal region by vulvoscopy. The technique of medical healthcare providers in our facility who perform vulvoscopy using regularly, was reviewed. Options for examination are a standard colposcope with an attached camera to project the image onto a flat screen for viewing, or a tripod mounted smart phone with blue tooth remote, connected to the flat screen wirelessly. Photographs are taken at each step of the examination. Maximal diagnostic information was gained using a step-wise approach to vulvoscopy, beginning from lateral to medial, external to internal, conducted in a standardized manner. The vulvoscopy protocol begins with examination of right and left labia majora, followed by sulci, and then labia minora, assessing for pathology, and followed by cotton swab (Q-tip) palpation used to assess for pain. Labia minora width (cm) is then measured and degree of resorption from posterior fourchette assessed. The glans clitoris is examined via cephalad retraction of the prepucial hood so the corona can be visualized to assess for presence of clitoral adhesions. Glans size is compared to size of the cotton swab. Lateral retraction of labia minora enables visualization of Hart's line and close inspection of the vestibule and urethral meatus. The ostia of minor vestibular glands are observed for erythema and Q-tip testing performed at 1:00, 3:00, 5:00, 6:00, 7:00, 9:00, 11:00 to evaluate for pain on a scale of 0-10. Speculum exam is then performed by rotating the speculum 90 degrees to evaluate presence of vaginal rugae, vaginal pathology, as well as quality of the anterior vaginal wall periurethral tissue.