To date, there are no studies investigating the efficacy of buffered lidocaine during procedures on the vulva. The vulva is a particularly sensitive region to have a biopsy performed because it has extensive innervation, a large blood supply and it involves a pelvic exam which can be associated with increased anxiety. As many OBGYNs know, the vulva can be affected by a variety of conditions both benign and malignant. A crucial aspect of caring for women with vulvar complaints is conducting biopsies of lesions to ensure no occult malignancy and/or to further classify a diagnosis with histology. Use of local anesthetic is standard of care during biopsy but can add to the pain and discomfort of an already painful procedure. Some sources recommend use of topical anesthetic prior to infiltration of lidocaine, particularly in the pediatric patient. However, this technique requires the topical anesthetic be applied 20-60 minutes prior to the biopsy, which may not be feasible in a busy outpatient practice. Currently, the American Board of Obstetrics and Gynecology suggests 8.4% sodium bicarbonate can be added to lidocaine to minimize discomfort. However, there is currently no standard anesthesia recommendations and this is often not being done in clinical practice.