Normal findings in vulvar examination and vulvoscopy

Br J Obstet Gynaecol. 1997 Mar;104(3):320-4. doi: 10.1111/j.1471-0528.1997.tb11461.x.


Objective: To determine the normal vulvar findings by naked eye examination and by vulvoscopy in healthy women without vulvar complaints.

Design: Observational study.

Population: Forty healthy volunteers without vulvar complaints recruited via a newspaper advertisement.

Methods: Vulvar examination, human papillomavirus (HPV) polymerase chain reaction of vulvar and cervical swabs, saline and KOH smears and vulvoscopy before and after the application of 5% acetic acid.

Main outcome measures: Prevalence of vestibular erythema, vestibular papillomatosis, HPV infection on the vulva and in the cervix and vulvoscopic findings.

Results: The mean age of the women was 37.8 years (median 38.0, range 21-56). Nine women were current smokers and 21 had previously smoked. Naked eye vulvar examination showed vestibular papillomatosis in 13 women (33%) and vestibular erythema in 17 women (43%). The touch test was positive in 9 of the 17 women (53%) with vestibular erythema. Vulvoscopy after the application of acetic acid 5% showed an acetowhite vestibule in all women. Twelve women (30%) had acetowhite lesions outside the vestibule. Six women (15%) were positive for HPV DNA. The presence of HPV DNA did not correlate with vestibular erythema or vestibular papillomatosis. There was a weak association between HPV DNA and acetowhite lesions outside the vestibule (P = 0.055, Fisher's exact test). In this group the younger women significantly more often had vestibular papillomatosis (t-statistic = 3.07; P = 0.003) and women who smoke more often had a genital HPV infection (P = 0.016, Fisher's exact test).

Conclusions: Vestibular erythema, vestibular papillomatosis, and acetowhite lesions are common in this group of healthy women without vulvar complaints.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Colposcopy
  • DNA, Viral / analysis
  • Female
  • Herpes Genitalis / pathology
  • Herpes Genitalis / virology
  • Humans
  • Middle Aged
  • Physical Examination
  • Sebaceous Glands / anatomy & histology
  • Simplexvirus / isolation & purification
  • Vulva / anatomy & histology*
  • Vulvar Diseases / pathology
  • Vulvar Diseases / virology


  • DNA, Viral