Vulval issues

General history

  • PMH, FH
    • Skin (atopy, psoriasis)
    • Autoimmune issues (thyroid, T1DM, vitiligo)
    • Lichen sclerosus or planus
  • DH
  • STI history

Vulval cancer

  • Lump, ulcer, bleeding
  • Tx
    • 2ww referral

VIN

  • Discoloration, warty change, history of CIN
  • Tx
    • Refer to vulval clinic

Post-menopausal atrophy

  • Tx
    • Ovestin cream 3/12 – if no response, refer to vulval clinic

Psoriasis

  • Dry, flakey skin (especially in hair bearing areas)
  • Tx
    • Moderate potency topical steroid BD 2/52 – then ON 2/52 – then taper
    • If no response in 6/52, refer to vulval clinic

Lichen simplex

  • Dry, lichenified skin, with a history of atopy
  • Ix
    • FBC + ferritin (replacing iron deficiency treats many cases)
  • Tx
    • Moderate potency topical steroid BD 2/52 – then ON 2/52 – then taper If no response in 6/52, refer to vulval clinic

Lichen sclerosus or planus

  • Pale, white, shiny skin (esp if vulval architecture is disrupted)
  • Ix
    • Bloods – TFT, HbA1c
  • Tx
    • High potency topical steroid ointment ON 1/12 (Clobetasol proprionate 0.05%) – reduce to alternate nights for 1/12 – reduce to twice/week – review in 6 months
    • Refer if no response in 6 weeks or not confident about diagnosis (or if sexual dysfunction present)