Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic

doi:doi:10.11648/j.jgo.20231103.12

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Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic

Published in Journal of Gynecology and Obstetrics (Volume 11, Issue 3)

Received: 11 June 2023 Accepted: 29 June 2023 Published: 8 July 2023

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Abstract

This study examined the distribution and characteristics of acetowhite staining (AWS) in three vulvar rings in women with chronic vulvar discomfort. AWS was monitored as a secondary outcome measure in the study DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy). The study included 328 consecutive participants, divided into four groups based on their medical history, results from the vulvodynia questionnaire designed by the International Society for the Study of Vulvovaginal Disease, and clinical examination. Asymptomatic participants were classified into a normal vulva group (N = 82) and an impaired vulvar skin group (N = 82). Patients with chronic vulvar discomfort were divided into primary vulvar distress/vulvodynia (N = 82) and secondary discomfort caused by vulvar dermatosis (N = 82). The clinical data collected from the three rings vulvoscopy (TRIV) were analyzed using statistical software such as StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study was conducted with the approval of the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The study's findings support the notion that AWS patterns can vary across different histological areas of the vulva and can indicate specific conditions. The higher incidence of AWS in the outer vulvar ring among patients with vulvar dermatosis (45.1%) suggests a widespread involvement in this area. In contrast, the study found that patients with vulvodynia (96.3%) and impaired vulvar skin (78.0%) exhibited a higher AWS frequency and a distinct pattern called the "O sign" in the inner vulvar ring. AWS in the middle vulvar ring was observed in all participants. However, there were noticeable differences between patients with vulvodynia and vulvar dermatosis, highlighting the potential diagnostic value of AWS distribution in this area. The faster onset of AWS in patients with vulvodynia (mean 51.6 seconds), a significantly higher frequency of sharp demarcation of AWS (49.4%), nontransparent AWS (16%), the "O sign" (81.7%) and provoked erythema (11.1%) supports the role of a potential inflammatory component in this condition in response to AWS. This specific pattern suggests that AWS combined with the TRIV approach can enhance the clinical recognizability of vulvodynia. The similarity in the distribution and characteristics of AWS in patients with vulvodynia and impaired vulvar skin suggests a potential connection between the two conditions and the progression or evolution of vulvodynia in the presence of impaired vulvar skin over time.

Published in	Journal of Gynecology and Obstetrics (Volume 11, Issue 3)
DOI	10.11648/j.jgo.20231103.12
Page(s)	61-72
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Acetic Acid Test, Acetowhite Staining, O Sign, Three Rings Vulvoscopy, Chronic Vulvar Discomfort, Vulvodynia, Vulvar Dermatosis

References

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[13]	González, M. G.-Y.; Muñoz Ledesma, A. M.; Monge, M. N.; Fontán, J. S. Colposcopy of the Vulva and Perineum Colposcopy of the Vulva and Perineum. Open Access Peer-Reviewed Chapter September. 2017. Available online: http://dx.doi.org/10.5772/intechopen.68768; Last accessed on February 19, 2023.
[14]	Micheletti L, Preti M, La Monica F. La vulvoscopia, no debe ser destinada como el examen colposcopico de la vulva. Arch. Med. Actual Tracto Genit. Inf 2011; 3: 29-34.
[15]	Reid R. Rational management of cervical and vulvar neoplasia. Contemp Ob Gyn 1993; 38: 92-112.
[16]	Santoso J, Likes W. Colposcopic acetowhitening of vulvar lesion: a validity study. Arch Gynecol Obstet 2015; 292: 387-390: DOI 10.1007/s00404-015-3666-5.
[17]	Harni V, Babic D, Barisic D. "Three Rings Vulvoscopy" – A New Approach to the Vulva. Gynaecol Perinatol 2015; 24: 37-45.
[18]	Harni V, Babic D, Hadzavdic S, Barisic D. Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1). Journal of Gynecology and Obstetrics 2022; 10 (1): 39-47. DOI: 10.11648.j.jgo.20221001.16.
[19]	Harni V, Babic D, Hadzavdic S, Barisic D. Clinical Value of the N-S-P Scheme for Detection of Vulvar Dermatosis (DATRIV Study, Part 2). Journal of Gynecology and Obstetrics 2022; 10 (3): 159-166. DOI: 10.11648.j.jgo.20221003.11.
[20]	Harni V, Babic D, Hadzavdic S, Barisic D. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. Journal of Gynecology and Obstetrics 2022; 10 (6): 243-252. doi: 10.11648/j.jgo.20221006.12.
[21]	ISSVD Vulvodynia Pattern Questionnaire. Available at: https://netforum.avectra.com/temp/ClientImages/ISSVD/3ef9c6ea-aac7-4d2b-a37f-058ef9f11a67.pdf; Last accessed on May 23, 2015.
[22]	Byrne MA, Walker MM, Leonard J, Pryce D, Taylor-Robinson D. Recognising covert disease in women with chronic vulval symptoms attending an STD clinic: value of detailed examination including colposcopy. Genitourin Med 1989; 65: 46-9.
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[31]	Lifits–Podorozhansky, YM; Podorozhansky, Y; Hofstetter, S; Gavard, JA. Role of Vulvar Care Guidelines in the Initial Management of Vulvar Complaints. J Low Genit Tract Dis 2012; 16 (2): 88-91.

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APA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. (2023). Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia. Journal of Gynecology and Obstetrics, 11(3), 61-72. https://doi.org/10.11648/j.jgo.20231103.12

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ACS Style

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic. Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia. J. Gynecol. Obstet. 2023, 11(3), 61-72. doi: 10.11648/j.jgo.20231103.12

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AMA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia. J Gynecol Obstet. 2023;11(3):61-72. doi: 10.11648/j.jgo.20231103.12

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@article{10.11648/j.jgo.20231103.12,
  author = {Vesna Harni and Damir Babic and Suzana Ljubojevic-Hadzavdic and Dubravko Barisic},
  title = {Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {11},
  number = {3},
  pages = {61-72},
  doi = {10.11648/j.jgo.20231103.12},
  url = {https://doi.org/10.11648/j.jgo.20231103.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20231103.12},
  abstract = {This study examined the distribution and characteristics of acetowhite staining (AWS) in three vulvar rings in women with chronic vulvar discomfort. AWS was monitored as a secondary outcome measure in the study DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy). The study included 328 consecutive participants, divided into four groups based on their medical history, results from the vulvodynia questionnaire designed by the International Society for the Study of Vulvovaginal Disease, and clinical examination. Asymptomatic participants were classified into a normal vulva group (N = 82) and an impaired vulvar skin group (N = 82). Patients with chronic vulvar discomfort were divided into primary vulvar distress/vulvodynia (N = 82) and secondary discomfort caused by vulvar dermatosis (N = 82). The clinical data collected from the three rings vulvoscopy (TRIV) were analyzed using statistical software such as StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study was conducted with the approval of the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The study's findings support the notion that AWS patterns can vary across different histological areas of the vulva and can indicate specific conditions. The higher incidence of AWS in the outer vulvar ring among patients with vulvar dermatosis (45.1%) suggests a widespread involvement in this area. In contrast, the study found that patients with vulvodynia (96.3%) and impaired vulvar skin (78.0%) exhibited a higher AWS frequency and a distinct pattern called the "O sign" in the inner vulvar ring. AWS in the middle vulvar ring was observed in all participants. However, there were noticeable differences between patients with vulvodynia and vulvar dermatosis, highlighting the potential diagnostic value of AWS distribution in this area. The faster onset of AWS in patients with vulvodynia (mean 51.6 seconds), a significantly higher frequency of sharp demarcation of AWS (49.4%), nontransparent AWS (16%), the "O sign" (81.7%) and provoked erythema (11.1%) supports the role of a potential inflammatory component in this condition in response to AWS. This specific pattern suggests that AWS combined with the TRIV approach can enhance the clinical recognizability of vulvodynia. The similarity in the distribution and characteristics of AWS in patients with vulvodynia and impaired vulvar skin suggests a potential connection between the two conditions and the progression or evolution of vulvodynia in the presence of impaired vulvar skin over time.},
 year = {2023}
}

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TY  - JOUR
T1  - Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia
AU  - Vesna Harni
AU  - Damir Babic
AU  - Suzana Ljubojevic-Hadzavdic
AU  - Dubravko Barisic
Y1  - 2023/07/08
PY  - 2023
N1  - https://doi.org/10.11648/j.jgo.20231103.12
DO  - 10.11648/j.jgo.20231103.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 61
EP  - 72
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20231103.12
AB  - This study examined the distribution and characteristics of acetowhite staining (AWS) in three vulvar rings in women with chronic vulvar discomfort. AWS was monitored as a secondary outcome measure in the study DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy). The study included 328 consecutive participants, divided into four groups based on their medical history, results from the vulvodynia questionnaire designed by the International Society for the Study of Vulvovaginal Disease, and clinical examination. Asymptomatic participants were classified into a normal vulva group (N = 82) and an impaired vulvar skin group (N = 82). Patients with chronic vulvar discomfort were divided into primary vulvar distress/vulvodynia (N = 82) and secondary discomfort caused by vulvar dermatosis (N = 82). The clinical data collected from the three rings vulvoscopy (TRIV) were analyzed using statistical software such as StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study was conducted with the approval of the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The study's findings support the notion that AWS patterns can vary across different histological areas of the vulva and can indicate specific conditions. The higher incidence of AWS in the outer vulvar ring among patients with vulvar dermatosis (45.1%) suggests a widespread involvement in this area. In contrast, the study found that patients with vulvodynia (96.3%) and impaired vulvar skin (78.0%) exhibited a higher AWS frequency and a distinct pattern called the "O sign" in the inner vulvar ring. AWS in the middle vulvar ring was observed in all participants. However, there were noticeable differences between patients with vulvodynia and vulvar dermatosis, highlighting the potential diagnostic value of AWS distribution in this area. The faster onset of AWS in patients with vulvodynia (mean 51.6 seconds), a significantly higher frequency of sharp demarcation of AWS (49.4%), nontransparent AWS (16%), the "O sign" (81.7%) and provoked erythema (11.1%) supports the role of a potential inflammatory component in this condition in response to AWS. This specific pattern suggests that AWS combined with the TRIV approach can enhance the clinical recognizability of vulvodynia. The similarity in the distribution and characteristics of AWS in patients with vulvodynia and impaired vulvar skin suggests a potential connection between the two conditions and the progression or evolution of vulvodynia in the presence of impaired vulvar skin over time.
VL  - 11
IS  - 3
ER  -

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Author Information

Vesna Harni

Department of Obstetrics and Gynaecology, Polyclinic Harni, Zagreb, Croatia
Damir Babic

Department of Pathology and Cytology, University Hospital Center, Zagreb, Croatia
Suzana Ljubojevic-Hadzavdic

Department of Dermatovenereology, University Hospital Center, Zagreb, Croatia
Dubravko Barisic

Department of Obstetrics and Gynaecology, Kardinal Schwarzenberg Klinikum GmbH, Schwarzach im Pongau, Austria

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APA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. (2023). Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia. Journal of Gynecology and Obstetrics, 11(3), 61-72. https://doi.org/10.11648/j.jgo.20231103.12

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ACS Style

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic. Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia. J. Gynecol. Obstet. 2023, 11(3), 61-72. doi: 10.11648/j.jgo.20231103.12

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AMA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia. J Gynecol Obstet. 2023;11(3):61-72. doi: 10.11648/j.jgo.20231103.12

Copy | Download

@article{10.11648/j.jgo.20231103.12,
  author = {Vesna Harni and Damir Babic and Suzana Ljubojevic-Hadzavdic and Dubravko Barisic},
  title = {Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {11},
  number = {3},
  pages = {61-72},
  doi = {10.11648/j.jgo.20231103.12},
  url = {https://doi.org/10.11648/j.jgo.20231103.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20231103.12},
  abstract = {This study examined the distribution and characteristics of acetowhite staining (AWS) in three vulvar rings in women with chronic vulvar discomfort. AWS was monitored as a secondary outcome measure in the study DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy). The study included 328 consecutive participants, divided into four groups based on their medical history, results from the vulvodynia questionnaire designed by the International Society for the Study of Vulvovaginal Disease, and clinical examination. Asymptomatic participants were classified into a normal vulva group (N = 82) and an impaired vulvar skin group (N = 82). Patients with chronic vulvar discomfort were divided into primary vulvar distress/vulvodynia (N = 82) and secondary discomfort caused by vulvar dermatosis (N = 82). The clinical data collected from the three rings vulvoscopy (TRIV) were analyzed using statistical software such as StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study was conducted with the approval of the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The study's findings support the notion that AWS patterns can vary across different histological areas of the vulva and can indicate specific conditions. The higher incidence of AWS in the outer vulvar ring among patients with vulvar dermatosis (45.1%) suggests a widespread involvement in this area. In contrast, the study found that patients with vulvodynia (96.3%) and impaired vulvar skin (78.0%) exhibited a higher AWS frequency and a distinct pattern called the "O sign" in the inner vulvar ring. AWS in the middle vulvar ring was observed in all participants. However, there were noticeable differences between patients with vulvodynia and vulvar dermatosis, highlighting the potential diagnostic value of AWS distribution in this area. The faster onset of AWS in patients with vulvodynia (mean 51.6 seconds), a significantly higher frequency of sharp demarcation of AWS (49.4%), nontransparent AWS (16%), the "O sign" (81.7%) and provoked erythema (11.1%) supports the role of a potential inflammatory component in this condition in response to AWS. This specific pattern suggests that AWS combined with the TRIV approach can enhance the clinical recognizability of vulvodynia. The similarity in the distribution and characteristics of AWS in patients with vulvodynia and impaired vulvar skin suggests a potential connection between the two conditions and the progression or evolution of vulvodynia in the presence of impaired vulvar skin over time.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Acetic Acid Test Performed by Vulvoscopy Had Revealed an "O Sign" in the Inner Vulvar Ring of Patients with Vulvodynia
AU  - Vesna Harni
AU  - Damir Babic
AU  - Suzana Ljubojevic-Hadzavdic
AU  - Dubravko Barisic
Y1  - 2023/07/08
PY  - 2023
N1  - https://doi.org/10.11648/j.jgo.20231103.12
DO  - 10.11648/j.jgo.20231103.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 61
EP  - 72
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20231103.12
AB  - This study examined the distribution and characteristics of acetowhite staining (AWS) in three vulvar rings in women with chronic vulvar discomfort. AWS was monitored as a secondary outcome measure in the study DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy). The study included 328 consecutive participants, divided into four groups based on their medical history, results from the vulvodynia questionnaire designed by the International Society for the Study of Vulvovaginal Disease, and clinical examination. Asymptomatic participants were classified into a normal vulva group (N = 82) and an impaired vulvar skin group (N = 82). Patients with chronic vulvar discomfort were divided into primary vulvar distress/vulvodynia (N = 82) and secondary discomfort caused by vulvar dermatosis (N = 82). The clinical data collected from the three rings vulvoscopy (TRIV) were analyzed using statistical software such as StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study was conducted with the approval of the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The study's findings support the notion that AWS patterns can vary across different histological areas of the vulva and can indicate specific conditions. The higher incidence of AWS in the outer vulvar ring among patients with vulvar dermatosis (45.1%) suggests a widespread involvement in this area. In contrast, the study found that patients with vulvodynia (96.3%) and impaired vulvar skin (78.0%) exhibited a higher AWS frequency and a distinct pattern called the "O sign" in the inner vulvar ring. AWS in the middle vulvar ring was observed in all participants. However, there were noticeable differences between patients with vulvodynia and vulvar dermatosis, highlighting the potential diagnostic value of AWS distribution in this area. The faster onset of AWS in patients with vulvodynia (mean 51.6 seconds), a significantly higher frequency of sharp demarcation of AWS (49.4%), nontransparent AWS (16%), the "O sign" (81.7%) and provoked erythema (11.1%) supports the role of a potential inflammatory component in this condition in response to AWS. This specific pattern suggests that AWS combined with the TRIV approach can enhance the clinical recognizability of vulvodynia. The similarity in the distribution and characteristics of AWS in patients with vulvodynia and impaired vulvar skin suggests a potential connection between the two conditions and the progression or evolution of vulvodynia in the presence of impaired vulvar skin over time.
VL  - 11
IS  - 3
ER  -

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