Symptoms of diseases of the female external genitalia are often expressed in pruritus and burning pain. To accomplish a targeted differential diagnosis an exact knowledge of anatomy is essential. An accurate anamnesis, a detailed inspection, and conducting a biopsy or microbiological smear lead to the correct diagnosis. Lichen sclerosus et atrophicus is the most common non-neoplastic disease of the vulva. This should be distinguished from amongst others lichen ruber planus, psoriasis, contact dermatitis of the vulva, or infectious diseases like condylomata acuminata, herpes genitalis, or mycosis.Preinvasive dysplastic alterations commonly cause symptoms comparable to benign diseases. Their appearance can be very heterogeneous. To avoid missing these conditions, it is often necessary to obtain a biopsy.Vulvar carcinoma occurs most frequently in the 8th decade. Nonetheless it should be included in differential diagnostic considerations in younger women since the incidence of the HP-positive variant is increasing in the younger age group.