Vulval self-examination and mobile selfie

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The vulva is an intimate and private part of the body. Vulval diseases include vulval infections and infestations caused by viral, bacterial, fungal, and parasitic infections in addition to well-known sexually transmitted diseases. Most of the time, females are a little bit embarrassed of vulval examination for so many reasons, such as lack of care, ignorance, privacy issues, inaccessibility to female doctors, and social restrictions. In this context, the importance of vulval self-examination (VSE) is the best way to diagnose early vulval diseases and cancers. The majority of women know about self-breast examination but are unaware of self-vulval examination. All sexually active women and women over 18 should perform VSE. It is better to start performing VSE at an early age; if possible, it should be taught at schools and colleges. Genital self-examination is divided into two parts, vaginal self-examination and VSE. Regular vulval examination is very important as it not only helps in diagnosing any abnormality but also makes women familiar with their vulva so that, in the future, they can detect any abnormality.^[1] Every vulva looks different. Normal vulvar anatomy knowledge is a must-know part of a woman’s life [Figure 1]. Depending on variables such as age, parity, ethnicity, body mass index, and hormonal influences, vulvar architecture varies both within and between individuals.^[2] During VSE, one should not experience discomfort. It should be done between the menstrual period on a particular date of every month. If one is no longer menstruating, a regular date should be set. If itching or pain, pain during sex, or any growth or change of skin texture is experienced, then VSE can be done at any time.^[2] In fair-skinned women, the vulva looks slightly erythematous, but in Fitzpatrick skin type III onward, diffuse hyperpigmentation is seen.^[3] Vulval cancer ranks fourth in terms of gynecologic malignancy and makes up 5% of all female genital tract cancers.^[4] Risk factors for vulvar cancer include older age (over 75 years), smoking, presence of diseases like lichen sclerosus, lichen planus, extramammary Paget’s disease, and HIV.^[5] VSE can distinguish between a number of dermatological disorders, including vitiligo, lichen planus, vulval wart, candida infection, and others [Table 1]. With a basic knowledge of a normal-looking vulva, it may also detect abnormal vulva characteristics according to age group,^[5] as shown in Table 2.

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Figure 1:

Normal vulval anatomy of a 12-year-girl child showing mons pubis (yellow star), anterior commissure (upper green arrow), posterior commissure (lower green arrow), clitoris (black arrow), urethral opening (black star), vagina (red star), labia minora (red arrow), and labia majora (yellow arrow).

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Steps for vulval examination, according to the Vulval Pain Society, the National Vulvodynia Association is shown in Figure 2.^[2,6]

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Figure 2:

Steps for vulval examination, according to the Vulval Pain Society, the National Vulvodynia Association.

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Nowadays, mobile photography is more common instead of using a mirror. While using mobile, it is critical to keep in mind that the flashlight should be on or the image should be taken in a well lit room. Images should be taken at different distances away from the lesions, such as 5 cm, 10 cm, 15 cm, and 20 cm, for better visualization. Privacy should be taken care of before taking a vulva selfie. The points to be noted are the device’s cloud-saving settings should be off, and a separate password-protected folder should be used.

Warning signs and symptoms:^[2]

• Changes in vulva skin texture and color, such as thickening, darkening, or whitening.

• Itching, burning, or pain in the vulva.

• Non-healing ulcers.

• Unusual growths on the vulva.

• Failure to topical treatments.

The European Federation of Colposcopy, International Society for the Study of Vulvovaginal Disease, European Society of Gynecological Oncology, and European College for the Study of Vulvar Disease recommended performing VSE starting at age 30 and scheduled 3 months apart. By performing such tests, women may be able to detect cancer or pre-cancer early on. However, many women may experience unpleasant emotions like anxiety during the test. These feelings can also be influenced by sociocultural background. The development of new technology aims to increase the precision of vulvar self-examinations.^[7] A few limitations of VSE include the inability to do the procedure when individual has the inability to bend the patient’s knees, elderly patients, individuals who are menstruating, individuals who are mentally unstable, or blind, etc. An app that distinguishes between normal and abnormal vulva would be more advantageous for all women. VBSE does not replace getting checked out by a medical practitioner. More studies are required to investigate the psychological and cultural obstacles to the adoption of VSE.