I had a Pap test on Monday, and the doctor said I had two white spots (loss of pigmentation) on my vulva. He said a steroid creme would probably take care of the itching there. He recommended a biopsy of the vulva. Is that really necessary?

F.L.

White spots and itching on the vulva may be due to benign conditions such as squamous cell hyperplasia, lichen sclerosis or even chronic yeast infections. It may also be a sign of vulvar dysplasia or cancer. Benign and premalignant lesions can look very similar to the naked eye; a biopsy is necessary to make a definitive diagnosis. Even in benign conditions, a biopsy can help pinpoint the exact cause of itching and, therefore, guide therapy.

A vulvar biopsy is quick and not too painful. Your doctor will cleanse the area and inject a small amount of local anesthetic. Usually a punch biopsy is done using an instrument akin to a small cookie cutter. Sutures are not needed in most cases. Sliver nitrate sticks or other methods are used to stop the small amount of bleeding. A biopsy is the best way to determine exactly what is causing your white itchy spots.