Skin conditions affecting the female genital skin are common and have a significant effect on quality of life. Although the risk is small, chronic inflammation in this area has potential to develop into neoplastic disease.
Refer to Genital Dermatology if:
- There is a dermatosis e.g. Lichen sclerosus, Lichen planus or eczema where primary care management has been unsuccessful. Please include a list of topical treatments tried.
- There is concern of an underlying Allergic Contact Dermatitis where primary care management has been unsuccessful. Please include a list of topical treatments tried.
- There is diagnostic uncertainty
Refer to 2ww Gynaecology if you are significantly concerned about vulval cancer:
- Asymmetrical lesion of unknown aetiology
- Unexplained lump, ulceration or bleeding
- Unexplained palpable mass or ulceration at the entrance to the vagina (not prolapse)
- The lesion is pigmented
Refer to General Gynaecology if:
- A vaginal or labial cyst has become so large that it causes discomfort e.g. on sitting, intercourse, walking, inserting tampon. It is likely that a small catheter will be inserted as a day case, to drain the cyst. This stays in for 4-6 weeks
N.B. cystic lesions are fluctuant and soft, Bartholin’s gland tumours are hard and indurated and usually painful.
- There is diagnostic uncertainty about a cyst
- Consider contacting the on-call gynae registrar if a cyst has become an abscess
- There are non-cosmetic concerns about labial injury after birth (non-acute phase). Acute tears will be dealt with by midwives
Refer to Brook (firstname.lastname@example.org) if concerns about:
- Recurrent vaginal discharge
- Probable genital warts
Surgery to the labia and vagina are not performed for cosmetic reasons
LICHEN SCLEROSUS follow up:
- Uncomplicated LS can be managed in Primary Care and diagnostic biopsies are only required if there is diagnostic doubt or failure to respond to treatment
- Once referred, all women ideally have initial 30 min appt and then a 3 month follow up appt to assess response to treatment.
- If well controlled and happy to be managed by GP then can be discharged with advice that GP needs to review them annually.
- Difficult to control LS will be kept under review until better.
- All the evidence suggests that if they are going to develop a vulval cancer, this can appear rapidly and in-between 3 monthly appts, so the annual follow up is probably more necessary to reinforce the message of self-examination and check that they are not having problems, rather than to pick up changes.
- All women with LS and LP should be warned about the potential for malignant change associated with these conditions and asked to report any changes to their GP for prompt referral back into the vulval clinic.
VULVAL DERMATOLOGY Patient information leaflets and useful advice for treatment: https://doclibrary-rcht.cornwall.nhs.uk/RoyalCornwallHospitalsTrust/Internet/DocumentsLibrary/PatientInformation/VulvalServices.aspx
Date: January 2021
Review Date: January 2022
Author: Dr S Burns
Contributors: Drs Lisa Haddon, Liz Venner, Sophia Julian, Lisa Verity RCHT
Version No. 1.1