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Vulva and Introitus

Biopsy of the Vulva

Excision of Urethral Caruncle

Bartholin's Gland Cyst Marsupialization

Excision of Vulvar Skin, with Split-Thickness Skin Graft

Bartholin's Gland Excision

Vaginal Outlet
Stenosis Repair

Closure of Wide Local Excision of the Vulva

Wide Local Excision
of the Vulva, With Primary Closure or Z-plasty Flap

Alcohol Injection
of the Vulva

Cortisone Injection
of the Vulva

Merring Operation

Simple Vulvectomy

Excision of the
Vulva by the Loop Electrical Excision Procedure (LEEP)

Excision of
Vestibular Adenitis

Release of Labial Fusion


Excision Of Hypertrophied Clitoris

Biopsy of the Vulva

Gross lesions of the vulva often seem to be benign. However, a gross lesion of any description on the external or internal female genitals is suspicious, and with rare exceptions, a biopsy should be taken for histologic analysis.

A histologic specimen encompassing pathologic as well as normal squamous epithelium is obtained from the vulva.

Physiologic Changes: None

Point of Caution: The biopsy should provide reliable pathologic specimens; tangential cutting may lead to misinterpretation.


The patient is placed in the dorsal lithotomy position. The area of pathologic abnormality is cleansed with antiseptic solution, and the proposed biopsy site is selected.

A Keys punch, commonly used by dermatologists, is excellent for this purpose. The 5-7 mm size allows appropriate pathologic specimens to be taken without leaving a defect large enough to require sutures.

The area is anesthetized with 1 mL of 1% Xylocaine injected subcutaneously. The biopsy is then taken by rotating the Keys punch over the skin in 180° arches.

A delicate forceps is used to elevate one margin of the biopsy, and a small cuticle scissors is used to dissect the biopsy off its bed. A suture is rarely required, and no dressing is applied.

The biopsy is oriented on a piece of saline-soaked gauze, enabling the pathologist to perform ideal sections.

If necessary, a plug can be cut from an Avitene or Gelfoam wafer by using the sharp edge of the Keys punch.

This plug can be placed in the biopsy defect to provide hemostasis. It will act as an excellent dressing for the wound and, in most cases, omit the need for suturing. The patient is instructed to keep the site clean with ordinary soap and water and to wear a perineal pad as required.


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