Twelve Steps to Proficiency in Diagnosis

  1. Avoid telephone diagnosis. Do not assume you know until you look.
  2. Implement a systematic approach to women who are symptomatic that you use every time.
  3. Take a targeted history. It may be more extensive than you think!
  4. Name things: the normal anatomy as you look at it and any lumps, bumps, and cracks or discoloration you see, using correct medical terminology. Document in the same way.
  5. Critically look at the anatomy and the skin, even in the asymptomatic patient, taking note of benign and abnormal changes.
  6. Learn the most common vulvar skin disorders so you can recognize them when you see them.
  7. Add vulvar biopsy to your skill list or recognize when to refer for biopsy.
  8. Add the “q-tip” test to exams to evaluate for pain syndromes and do not forget, in questions of pain, to test for tone of the pelvic floor.
  9. Improve microscope skills, understanding how pH fits into normal and abnormal findings.
  10. Understand which lab tests to order and which will not help you. Use yeast cultures more.
  11. Keep a list handy of appropriate treatments for the conditions you learn about.
  12. Look for combinations of disorders. Keep an open mind and evaluate objectively.


Review this website with dedication and you will become an expert!