Vulval biopsy

Your nurse or doctor has suggested that you have a small sample of skin taken from the vulva for detailed examination under the microscope. This information leaflet will give some more information about this special test and will answer some questions you may have about this.

What is a vulval biopsy?

A biopsy is the removal of a small piece of tissue from a person for the purpose of testing that piece of tissue. In your case, the biopsy is to be taken from the vulva.

Why do I need a biopsy from the vulva?

You have a problem in the vulval area. This may be pain or itching, an ulcer or lump, or blisters or a rash. Sometimes it is not possible to know exactly what is wrong with the skin just from looking or by taking other tests such as blood tests or swabs. If this is the case, then a biopsy can often give very useful information that can help to make a diagnosis or to suggest suitable treatment.

Where and when will the biopsy be done?

The biopsy is a small operation and so is usually done in a special room in clinic. You may be asked to come back on another day for the biopsy or it may be done on the same day as your clinic appointment.

What do I need to do before the biopsy?

• You do not need to do anything special before the biopsy.
• However, if you have the chance, it would be good to have a bath or shower on the day of the biopsy and to wash the skin gently but thoroughly.
• You could take paracetamol about 30 minutes before the biopsy to help reduce the discomfort
• You will feel easier if you wear comfortable clothes.
• It will help to wear or bring some close fitting pants (not a thong) into which a light pad can be put if necessary.
• Eat light meal(s) as normal.
• Before the biopsy is done, you will be asked to give your consent to the procedure.
• You will also have the opportunity to ask any questions or ask for more information.

What will happen in the biopsy room?

• You can ask for a friend or relative to be in the biopsy room with you if you like.
• Young children cannot come into the biopsy room and so you should arrange for someone to look after your children whilst the biopsy is done.
• You will be asked to undress below the waist and to rest on your back on a couch. This may be a normal couch or it may be one in which your legs are lifted up into supports (‘stirrups’).
• The skin at the site of the biopsy will be anaesthetised with local anaesthetic. This is usually done with a small needle injection and is uncomfortable for a minute or two.
• When the skin is numb, a piece of skin will be removed – this is usually half to 1cm across. The site of the biopsy will be closed.

Will I have stitches?

A biopsy makes a hole in the skin that usually has to be closed with one or more stitches. The stitches may need to be removed after five to ten days or the type of stitch used may dissolve and fall out by themselves. Occasionally the hole in the skin made by the biopsy can be closed without stitches. The doctor or nurse should be able to tell you before the biopsy if they plan not to use stitches. This can be done using:

• Monsel’s paste or silver nitrate – this seals the area. Afterwards you may have a discoloured discharge for a day or two.
• Cautery – a small electrode is used to seal the area. A scab forms which separates and drops off after a few days.

How long will the biopsy take?

It usually takes 20 to 30 minutes from the time you go into the room until you go out again.

How long will it take for the anaesthetic to wear off?

The anaesthetic usually wears off after about half an hour. The biopsy site will feel a little sore. You may feel more comfortable if you take a pain killer such as paracetamol or ibuprofen.

Will I be able to drive home or go home by myself on the bus?

Having a biopsy taken from the skin is about the same, in terms of discomfort and worry, as having a filling at the dentists. If you know that you feel worn out after something like that, you may feel better to arrange for someone to take you home afterwards. It is a good idea to rest for a couple of hours after the biopsy to minimise the chances of bleeding from the wound. We would advise that you avoid heavy work or prolonged standing for the rest of the day after a vulval biopsy.

How can I wash or go to the toilet after the biopsy?

You will of course have to go to the toilet! If you have the opportunity to wash the vulval skin with plain water after you pass water, you will find that soothing. Otherwise, you can just wipe the skin gently with paper as normal.

When you have the bowels open, make sure that you wipe the skin in a direction away from the vulva, to keep the biopsy site as clean as possible. Again, if you have the opportunity to rinse the skin fully after going to the toilet, that will help to keep the wound as clean as possible.

Please continue to wash the vulval skin every day as normal. It is best to wash the skin with water alone. This is easiest in a shower, but if you take a bath, make it a quick but thorough rinse and avoid soaking in the bath for the first two to three days after the biopsy to allow the wound to dry out. After washing, it is important that you dry the area thoroughly. This can be done by gently dabbing the area (do not rub) or by using a hairdryer set on ‘cool’.

When can I get back to normal after the biopsy?

• It will take a few days for the skin to heal up and you will probably find the area is tender.
• It may sting when you pass water, and you may find that loose clothes are more comfortable for a couple of days.
• Vigorous exercise such as running, cycling, horse riding etc. should be avoided for a few days after the biopsy as the area is likely to be uncomfortable and the biopsy site will be fragile.
• You can resume sexual intercourse after three or four days if the area is fully comfortable.
• If you are a regular swimmer, you can start swimming again after the stitches have been removed or dissolved or after the biopsy site has healed fully.

What are the risks of having a vulval biopsy?

There are some small risks from a procedure like a vulval biopsy. They are:

• The biopsy will leave a small scar on the skin.
• There will be some bleeding at the time of the biopsy, but the operator will aim to stop this before you leave the biopsy couch. Occasionally, the bleeding starts up again later on in the day. If this happens, you should press on the skin for 15 minutes whilst resting lying down. If the bleeding does not stop then, you should contact the clinic or the accident and emergency department at the local hospital.
• The small wound in the skin can allow infection to get into the body. If this happens, the site of the biopsy will feel more uncomfortable and hot as the days go by and may start to ooze. If this happens, you should contact your doctor as you may need antibiotic treatment.

When will I get the result?

The result of the testing of the piece of vulval skin usually comes through after two to three weeks. Your doctor or nurse will arrange to contact you or see you again when the result is through and to talk about any treatment that might be advised. If you have not heard anything by six weeks after the biopsy, please contact the clinic in case we have had difficulty in contacting you.