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Feature Article

Vulval disease. Part 1: a dermatogynaecological approach

Gayle Fischer, Jennifer Bradford

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Abstract

Management of vulval conditions may not be straightforward and may be coloured by concurrent dermatological, gynaecological, urological and psychosexual problems. An approach that integrates the disciplines of dermatology and gynaecology is optimal.

Key Points

  • The vulva is part of the skin and the majority of patients presenting with vulval symptoms will be suffering from a dermatological complaint. A dermatological history is essential.
  • With the exception of patients who experience only pain, dyspareunia or burning, the nature of the patient’s symptoms is rarely a clue to the diagnosis.
  • Vulval rashes can be subtle, and initial examination may suggest a normal vulva. Inspect the rest of the skin, the nails, scalp and oral mucosa for clues.
  • Environmental modification is always the first step in management of any vulval problem. Skin of the vulva, rather like that of the hand, is particularly prone to a number of adverse environmental influences.
  • Dermatological conditions are often chronic and need ongoing maintenance treatment. This may mean abandonment of cherished but inappropriate personal hygiene routines. Continued positive reinforcement is necessary to encourage compliance.
  • An understanding of the impact of vulval disease on a patient’s life and a supportive clinical relationship are essential.

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