Microscopy, KOH, and pH testing

The four pillars of vulvovaginal diagnosis

1. History

2. Physical Exam

3. pH, wet prep, KOH

4. Biopsy

Because of inadequate training, lack of equipment, isolation of the clinician at the microscope, and time pressure in office sessions, microscopy, pH, and KOH testing of vaginal secretions may be the weakest of the four pillars of vulvovaginal diagnosis.