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In addition to inspection, several other diagnostic aids are available. Papanicolaou (Pap) smears of the vulva, although generally not obtained, may be useful for ulcerated lesions. A saline-moistened tongue depressor or similar spatula is used to scrape the lesion for a specimen, which is then smeared on a slide for vulvodynia.

Biopsy of the vulva. After local anesthetic infiltration, a 4 or 5 mm Keyes punch is pressed into the lesion with a rotating motion, until the skin has been fully penetrated.

Two of the most common vulvar disorders, herpes simplex vulvitis (herpes genitalis) and condylomata acuminata, do not normally require biopsy and should be treated by primary care providers. Both are sexually transmitted infections, and testing for other sexually transmitted diseases should be done in patients with either type of lesion. Herpetic vulvitis presents with painful, tender vesicles.

Lesions suspected to be herpetic should be cultured to confirm the diagnosis. Syphilis, chancroid (which is endemic in some regions of the United States), and Behcet's syndrome can also cause vulvar ulcers.

Treatment consists of acyclovir 200 mg five times daily or 800 mg twice daily for 7 to 10 days in primary disease or for 5 days in recurrent attacks. This therapy has been shown to reduce the duration of episodes.

Condylomata acuminata are easily recognized by their warty, cauliflower-like appearance. In case of any uncertainty, a biopsy provides confirmation. Condylomata acuminata frequently involve the cervix.

Therapy should begin with the treatment of any associated vaginitis as well as other measures to reduce local moisture. The patient should wear loose cotton undergarments and avoid tight clothing, local creams, and sprays. For small lesions (under 2 cm), application of a 20% solution of podophyllum.

For recurrent and persistent condylomata, interferon has been used, both alone and in combination.