This area of study, again, proves that the “biopsy” is not a “laboratory test” but a medical consultation. For this reason, the dermatopathologist is encouraged to communicate with the clinician as clinicopathologic correlation is almost always essential in diagnosis of external genital diseases. This is due to a variety of reasons but most important is that affected patients commonly delay seeking medical attention and often use self-prescribed (over-the-counter) treatment regimens, which often causes the biopsy specimens to exhibit multifactorial pathologic changes; for example, self-induced allergic and irritant contact dermatitis often complicates the histologic picture of other underlying afflictions, especially in the evaluation of biopsies of inflammatory diseases, and sometimes neoplastic lesions. Clinical photos of complex genital lesions can be a valuable tool such that the morphology and distribution of lesions on these specialized mucocutaneous surfaces can provide a better interpretation of the histopathologic findings.1 For example, the term “glazed erythema” may be unfamiliar to the unalerted pathologist as it is a common descriptor for the shiny red lesions of plasma cell (Zoon) mucositis and lichen planus on the genital squamous mucosa. The reader is referred to the authoritative and highly regarded compendium on clinical signs and symptoms of genital disorders—Genital Pathology Atlas and Manual by Lynch and Edwards2—serving as an excellent clinical companion to this chapter.
Some providers who have specialized in the clinical care of females have adopted the designation as “vulvologists,” and include dermatologists, gynecologists, urologists, and generalists, but a similar specific joint assemblage does not exist for the care of men. Many of these specialists in the care of women have joined to form study groups; of particular note, the International Society for the Study of Vulvovaginal Disease (ISSVD) was formed in 1970 and has advanced the care of women greatly in this field. However, the specific study of external genital pathology is yet to be claimed by any specialty, and more studies are much needed in both sexes. Genital disorders are increasingly evaluated by dermatologists and dermatopathologists.
ANATOMY OF THE EXTERNAL GENITALIA
In the female, the vulva is the diamond-shaped anatomic region bounded anteriorly by the mons pubis, laterally by the crural folds, and posteriorly by the vaginal fourchette, as it borders the perineum (Fig. 38-1). Medial to the crural folds are the paired labia majora. Medial to the labia majora are the paired labia minora, separated by a linear depression known as the interlabial sulcus. The vaginal vestibule is the region bounded anteriorly by the clitoral frenulum, laterally by the labia minora, and posteriorly by the fourchette. Hart line exists at the border between the labia minora and vaginal vestibule and is a grossly visible thin pale line, representing the transition between the labia minora and the vaginal vestibule (more on this below). The labia minora bifurcate at the clitoris, anteriorly forming the clitoral hood ...