A multidisciplinary vulva clinic: the role of genito-urinary medicine

• Published in: Journal of the European Academy of Dermatology and Venereology Vol. 13; no. 1; pp. 36 - 40
• Main Authors: Sullivan, A.K., Straughair, G.J., Marwood, R.P., Staughton, R.C.D., Barton, S.E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.1999
• Subjects: Genito-urinary medicine; Multidisciplinary; Vulva clinic
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.1999.tb00841.x

Objectives To characterise the new patient referrals to a combined vulva clinic and to assess the role of genitourinary services within the clinic. Methods A case note review of all new patients attending a monthly, multidisciplinary vulva clinic over a 12‐month period. Results The mean age of the 135 women was 43 years (range 18–86 years). The majority of patients, 64 (47%), were referred by their general practitioner (GP). Using nurse and physician triage 85 (63%) patients were seen by a dermatologist, 55 (41%) by a genitourinary medicine physician, 38 (28%) by a gynaecologist and six (4%) by a psychosexual physician. Fifty‐one (38%) women required a consultation by at least two specialties. Itch was the most frequent presenting symptom (70%) and 59 (44%) women had experienced symptoms for between 6 months and 2 years. A previous STD screen had been performed in only 57 (42%), which was negative in 45 (79%). The most frequent initial clinical diagnoses were lichen sclerosus (35, 26%), vaginal candidiasis (21, 16%), vulvodynia (16, 12%), lichen simplex chronicus (13, 10%) and Bowenoid papulosis (13, 10%). Thirty‐eight (28%) women had microbiological investigations revealing 13/135 (10%) had vaginal candidiasis and two (2%) bacterial vaginosis, all symptomatic. A biopsy was performed in 32 (24%) confirming the initial diagnosis in 20 (63%) cases. Treatment was initiated in 101 (75%) women: 62 (46%) were prescribed steroid cream, 46 (34%) emollient cream and 22 (16%) treatment for Candida infection. Fifty‐three (39%) women received more than one treatment. 94 (70%) patients were followed‐up in the vulval clinic, five (4%) in the genitourinary clinic and 12 (9%) by their GP. Conclusions Despite having genitourinary symptoms less than half the patients had been tested for infection prior to attending the clinic. More than a third of the patients, 46 (34%), were diagnosed with a genitourinary infection. There is a significant role for genitourinary services in the diagnosis, management and ongoing care of patients in a vulva clinic.