A vulvar biopsy is a diagnostic procedure where a small sample of tissue is removed from the vulva for laboratory analysis. The vulva includes the external female genitalia, such as the labia and clitoris, and the biopsy is performed to investigate abnormal skin changes in this area. It is a common and quick test typically performed in an office setting.
Why a Biopsy is Necessary
The primary reason for performing a vulvar biopsy is to investigate abnormal skin changes that cannot be definitively diagnosed through visual examination alone. These changes may include persistent itching, discoloration, lumps, sores, or areas of thickened or altered skin texture on the vulva. The procedure provides a tissue specimen for a pathologist to examine microscopically, which is necessary to confirm or rule out various conditions.
The biopsy provides a definitive diagnosis when initial treatments for common issues like contact dermatitis have been unsuccessful. It helps identify specific chronic inflammatory or pre-cancerous conditions, such as lichen sclerosus or vulvar intraepithelial neoplasia (VIN). Furthermore, a biopsy is the definitive method to rule out or confirm invasive vulvar cancer, guiding subsequent treatment decisions.
Preparing for the Procedure
Before the procedure, patients receive specific instructions to ensure the area is ready and to minimize the risk of complications. If you are taking any blood-thinning medications, such as aspirin or warfarin, your healthcare provider will likely advise you to temporarily stop them a few days before the biopsy to reduce the risk of bleeding. It is important to discuss all prescription and over-the-counter drugs with your provider well in advance.
Patients may be asked to discontinue the use of topical creams, ointments, or douches on the vulva for a few days before the appointment. While the procedure can often be done regardless of the menstrual cycle, some providers prefer to schedule it outside of heavy flow days. Since the procedure uses a local anesthetic, you can usually eat and drink normally beforehand, and transportation is generally not required.
The Biopsy Process
A vulvar biopsy is a relatively quick procedure, often taking less than 30 minutes, and is performed with the patient positioned similarly to a routine pelvic exam. The area is first cleaned with an antiseptic solution to minimize the risk of infection. A local anesthetic, typically lidocaine, is then injected into the biopsy site to numb the tissue, which may cause a brief stinging or burning sensation that quickly fades.
Once the area is numb, the provider uses a specialized instrument to obtain a small tissue sample, typically using either a punch or shave technique. A punch biopsy uses a small, circular cutting tool to remove a cylindrical core of tissue, ensuring the sample includes deeper skin layers. A shave biopsy uses a sharp blade to remove a more superficial layer of skin, typically used for raised lesions.
After the sample is collected, the provider manages any bleeding at the site. This may involve using a single dissolvable stitch for punch biopsy sites, or applying hemostatic agents like silver nitrate to stop the bleeding. The tissue sample is then sent to a pathology laboratory for microscopic analysis.
Recovery and Understanding Results
Following the procedure, you should expect some mild and temporary side effects at the biopsy site. These commonly include a slight discomfort or soreness, minor bruising, and a small amount of light bleeding or discharge. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can usually manage this mild pain.
Specific aftercare instructions are provided to promote healing and prevent infection. You should keep the area clean and dry, gently washing with water and patting the area dry with a clean towel. Providers may suggest sitz baths and advise avoiding vigorous exercise and sexual activity until the wound has fully healed (up to two weeks). Seek medical attention if you experience signs of infection, such as fever, heavy bleeding, or increasing redness, swelling, or foul-smelling discharge.
The tissue sample is analyzed by a pathologist, who determines the nature of the cells and provides a diagnostic report. Results are generally available within one to three weeks. The findings classify the tissue as benign, pre-cancerous, or cancerous, allowing your healthcare provider to discuss the next steps, which may involve monitoring, treatment, or ongoing management.