Vulvoscopy: review of a diagnostic approach requiring clarification.

The objective of this review is to clarify what, if any, role there is for colorimetric (acetic acid and toluidine blue) testing and colposcopic examination of the vulva by reviewing the literature regarding use of the colposcope and colorimetric tests in the diagnosis of vulvar disorders. The lack of established usefulness of colposcopic observation for common dermatologic entities affecting the vulva markedly reduces the need for the colposcopist's skills in dealing with disorders of the vulva. Conversely, vulvar, as opposed to cervical, disorders place more emphasis on a gynecologist's knowledge and experience with dermatologic disease. The use of the colposcope and acetic acid, toluidine blue or both adds little or nothing to "naked-eye" examination of the vulva. The term vulvoscopy is appropriate and useful because it is easy to comprehend. However, vulvoscopy should be defined as a composite diagnostic act composed of careful naked-eye and low-power magnified examination carried out by those with interdisciplinary skills, such as vulvologists.