Whitish genital lesions

A woman aged 40 years presented for a cervical screening test (CST). She was a mother of three and a recently arrived refugee. She had never had a Pap smear or CST in the past because she had been living in a remote area for decades. The purpose of the test was fully explained to the patient. When asked before the procedure about routine symptomatology including menstruation, discharge and itchiness, the patient had no complaints.

During the procedure, in the presence of a chaperone female practice nurse, whitish discolouration of the vulva, involving both labia majora and minora, and clitoris with distorted anatomy was noted (Figure 1). On further enquiry, the patient stated she had experienced mild pruritus for several years, and she thought it was due to friction from walking.