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Commentary: "Three Rings Vulvoscopy": A New Approach to the Vulva (pp. 145-154) $0.00
Authors:  (Vesna Harni, Damir Babic, and Dubravko Barisic, Ginecological Clinic Dr. Vesna Harni, Zagreb, and others)
In the attempt to colposcopically examine the vulva, it is essential to know the histology of vulvar skin, since the complexity of the vulvar anatomy requires a different assessment of the seemingly same types of lesions in this area. Thickness of the vulvar skin affects the opacity; the vascular patterns are less marked and less marked and less reliable than with colposcopy of the cervix. Vascular aberrations, such as punctuations and mosaic, can be practically seen only on the inner portions of the labia minora where the
keratin layer is thinner and vestibular epithelium does not contain a keratin layer [1].
The most recent classification of vulvar diseases by the International Society for Study of Vulvovaginal Disease (ISSVD) and the International Federation for Cervical Pathology and Colposcopy (IFCPC) from 2011 introduced a detailed description of vulvar lesions according to dermatological criteria, which includes various variables that characterize each lesion by its size, location, type, color and secondary morphology according to dermatological criteria [2, 3]. Implementation of these recommendations in daily gynecological practice results in further efforts to assess and plan the treatment of vulvar lesions.
Vulvodynia is another issue, defined as vulvar discomfort, most often described as burning pain, occuring in the absence of relevant visible finding or a specific neurological disorder, which is diagnosed using Friedrich’s criteria and “per exclusion” [4–7].
Symptoms that indicate disease of the vulva include burning, stinging, soreness, irritation, feeling as if being cut with a knife or paper, stabbing, sticking, itching, inflammation and pain [8]. Very often there are no differences in symptoms between vulvar dermatosis and vulvodynia.
This was the reason for testing a new concept of vulvoscopy adapted to the anatomy of the vulva, according to the differences in histological structure and embryological origin of the vulvar structures. 

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Commentary: "Three Rings Vulvoscopy": A New Approach to the Vulva (pp. 145-154)