Diagnosis and management of vulvar and vaginal intraepithelial neoplasia

Vulvar and vaginal intraepithelial neoplasia are being encountered more frequently in younger women. Histologic evaluation is mandatory for an accurate diagnosis. Association with human papillomavirus infection and the multifocal nature often make treatment difficult; recurrences are not uncommon. The goal of therapy is to eliminate uncomfortable symptoms and malignant conversion while preserving lower genital tract appearance and function. Treatment must therefore be individualized for each patient to maintain vulvovaginal function and to avoid compromise to the clitoris, urethra, or anus while alleviating symptoms and preventing disease progression.