Good lighting and a magnifying glass are helpful to achieve a thorough inspection of the vulva. A precise description of lesion type and location should be documented in the medical record. Use of a diagram or photograph can be very helpful. Use of a speculum to examine the vagina and cervix is also important and vaginal pH should be measured. Normal pH range in reproductive age women is 3.8 to 4.2. An elevated pH is suggestive of atrophic change or an infectious process such as trichomoniasis or bacterial vaginosis.
A microscopic evaluation of vaginal discharge with both saline and KOH is essential in every woman with a vulvar or vaginal complaint. Scraping of the vulvar skin and inspection with KOH prep are also useful for possible dermatophyte or tinea infection. Inspection of the nongenital skin and oral cavity is also important.
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