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An adequate and unified classification of vulvar pathology has been difficult and continues to be a problem hard to solve, due to the difficulties in including different clinical aspects in various pathological classes. The causes of this uncertainty, as rather a multiplicity of view points, may be ascribed in particular to the extreme polymorphic nature of vulvar pathology. Our classification, in attempting to overcome arbitrary and absolute distinctions in such a polymorphic and variable field, adopts an etiological and anatomo-histological criterium which distinguishes vulvar pathology in: primary disorders, secondary disorders. It is evidently important to know and distinguish possible vulvar infections, in order to be able to identify those disorders which assume an oncogenous risk, while trying to overcome the problems of differential diagnosis.

Plain films of the abdomen taken during pregnancy at term from 1971 to 1981 at the Radiology Service of the Obstetric and Gynecological Clinic of the University of Padua are summarized and analysed. The average frequency of X-ray investigation is 0.5%, ranging from 0.06% (in 1980) to 2.11% (in 1977), compared to Carmichael's data which range from 11 to 30%. Indications have remained fairly constant over the years, in view of the very low incidence of this examination. The most significant finding is the greater incidence of fetal malformation in recent years, and is explained by a more efficacious program of pregnancy screening. X-ray examination may be still employed in some cases to obtain superior information regarding the best definition of gestational age, some fetal malformation, and in rare cases, hemolytic disease.

The Authors have studied the topical use of progesterone gel in the treatment of vulvar dystrophies. The results compared with those obtained previously with testosterone propionate pointed out the positive effects even of the progesterone, which has to be the first therapeutical approach for all the types of vulvar dystrophies, reserving to serious and resistants cases the treatment with testosterone propionate.

In the vulvar pathology surgery unit we have come across 3 patients with Sjögren's syndrome. Two of them also now show the presence of vulvar carcinoma, and one of them shows the presence of vulvar dystrophy with dysplasia. This has induced us to consider the possible connections between the 2 pathologies. All 3 of the patients, at different times and in different periods have been treated with steroids for the original disorder. The connections between the 2 affections are presumably to be found in the possible autoimmunitary genesis of the original disease and in the concomitant use of steroids.

In confronting the problem of prevention and early diagnosis of vulvar lesions at risk, the diagnostic methodology for their recognition and the therapeutic measures best taken are discussed. Through the use of routine, ambulatory screening tests, it is possible to detect and recognize those pathological situations which may evolve towards neoplasia. Among these, the vulvar dystrophies, some viral infections and sexually-transmitted diseases are particularly at risk. Patients with oncologic precedents are also at risk as well as patients receiving immunosuppressive therapy.

Hormone receptor assays for testosterone, estrogens and androgens were performed on 53 biopsy specimens of vulva from 40 patients, consisting of 6 with normal tissue, 14 with atrophic type dystrophy, 13 with hypertrophic type dystrophy, and 20 with malignancy. Atrophic and hypertrophic forms showed a different receptor pattern; hypertrophic forms were characterized by consistently higher levels of progesterone receptors not correlated with estrogen receptors. Neoplastic tissue showed no significant changes in values compared to normal or dystrophic forms, but range of variability was high. The bond between neoplastic forms and hormone activity seems without doubt less important than in the corresponding endometrial and mammary forms. The study of dystrophic forms, instead, should be further explored with a larger number of cases.

Assays have been developed for the quantitation of androgen, estrogen and progesterone receptors in the cytosol of 45 vulvar dystrophic tissues. In 27 patients we assayed only cytoplasmatic receptors, while in 18 patients both cytoplasmatic and nuclear receptors. The workers verified the possibility to assay these carriers, finding significant correlations neither with patient's age nor between atrophic and hypertrophic dystrophies. The research concerning the cytoplasmatic depletion and nuclear accumulation allowed us to understand the action mechanism of the androgen in vulvar tissues in patients in menopause.