Vulval clinic - having a vulvoscopy or vulval biopsy

The vulva is the external part of female genitalia. It includes 2 hair-covered folds of skin called the labia majora, which surround two thin and delicate folds called the labia minora. Between the labia minora is the opening of the vagina and the tube through which urine is passed (the urethra). The clitoris is positioned above the urethra. 

You have been referred to the clinic to investigate changes to the vulva, such as itching, burning, pain, swelling, or a change in colour or texture of the labia. 

The vulval clinic is based in Greenoaks at Rotherham Hospital. You are welcome to bring a person with you for support. 

After discussing your medical history and your current concerns, you may be offered a vulval examination.

This requires you to remove clothing below the waist. If you wear a loose skirt, this can be kept on. A sheet will always be provided to cover your waist and upper legs.

The nursing staff will help you to lie back on a flat couch, with your feet together and your knees relaxed apart.

A doctor or specialist nurse will look at your vulva and may need to touch the skin. They may also offer you an examination of your vagina using their finger or a speculum.

It may be recommended to look at the vulva in closer detail using a special microscope called a colposcope.

The nursing staff will help you to lie back on a special couch with your legs in supports.

The colposcope stays outside your body and does not touch you. There is a television screen connected to the colposcope so you can watch the examination if you wish. We may take a photograph of your vulva to store in your patient record. The photograph may help to monitor any changes seen.

The doctor or specialist nurse will apply a liquid called acetic acid to the skin on your vulva using cotton wool. This highlights any abnormal areas.

Vulvoscopy is a simple and safe technique. 

It is the best way of investigating changes to the vulva, or how effective a previous treatment has been.

There are no risks to a vulvoscopy.

Sometimes it is not possible to know exactly what is wrong with your vulva just from looking. A vulval biopsy is a minor procedure in which a small sample of skin which is taken from the vulva and sent to the laboratory to be examined. This can help to make a diagnosis or suggest a suitable treatment.

• The doctor will inject a local anaesthetic into the vulva. This means you are awake, but the area that needs a biopsy is numb (you cannot feel it). The injection might sting for a short time.
• The doctor will remove one or more small pieces of tissue.
• You may require stitches to the area where the biopsy has been taken. The stitches will dissolve and fall out on their own in 7 to 10 days.
• Once the procedure is finished you will be taken to the recovery area and monitored for 30 minutes, until you feel well enough to go home.

Vulval biopsy is a simple and safe technique. 

It helps to ensure you are diagnosed correctly and receive the most suitable follow-up.
 

• Scarring: There is a risk that the biopsy may leave a small scar on your skin.
• Bleeding: There is a small risk of bleeding that does not stop when you apply pressure with cotton wool for 15 minutes.
• Infection: There is a small risk of infection. The site of the biopsy may feel hot or more painful, or may start to ooze.
• Pain: There is a very rare risk that the scar will be painful long-term

• Some bleeding for up to a week. Wear a sanitary towel for several days and change this regularly to help prevent infection.
• Some discomfort. It may sting when you pass urine, and you may find that loose clothes are more comfortable for a couple of days after the procedure.
• Most people are able to return to work immediately after having a vulvoscopy, but after a vulval biopsy you may be advised to rest and avoid work or exercise for a few days.

If you are concerned that you are bleeding too heavily or have an infection please contact your GP, or Ward B11 (open 24 hours a day) on 01709 424349.

Until the site of the biopsy has completely healed, it is recommended to avoid:

• penetrative or oral vaginal sex – including fingers, tongues and other objects
• vigorous exercise - such as running, cycling, horse riding - as the biopsy site will be fragile
• swimming and hot tubs
• baths - you can shower as normal 

• If you are having your period, we can still carry out a vulval examination or vulvoscopy if your bleeding is light. Please call Greenoaks for advice before cancelling your appointment.
• Vulvoscopy is safe during pregnancy.
• Please make sure you eat and drink something before your appointment.
• Avoid applying any oily or greasy cream to the vulva that may be difficult to wipe off.
• If you take any medication to prevent blood clots (e.g. aspirin, warfarin, heparin, clopidogrel) please tell us before you come for your appointment. These medications can increase the risk of bleeding if you have a vulval biopsy.
• Bring a list of your medications to show your doctor.
• Please tell your doctor if you have any upcoming holidays, as it may affect your care plan. We may need to delay a vulval biopsy until after your return home, because of the risk of bleeding and infection. In addition, some travel insurance companies will not provide you with cover immediately following a vulval biopsy.
• You will be safe to drive following a vulvoscopy or vulval biopsy, unless advised otherwise.
• Take normal pain medication such as paracetamol or ibuprofen to help with any discomfort

If you have a vulval biopsy, we aim to write to you within 4 weeks with your results. The letter will explain if you are recommended to have any more tests, treatment or a follow-up appointment.

Greenoaks

Monday to Friday, 9am to 4pm
01709 427641

Gynaecology secretary

Monday to Friday, 9am to 5pm
01709 424300