{"id":11367,"date":"2022-10-13T09:29:03","date_gmt":"2022-10-13T08:29:03","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=11367"},"modified":"2026-02-16T09:30:10","modified_gmt":"2026-02-16T09:30:10","slug":"vulval-disorders","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/vulval-disorders\/","title":{"rendered":"Vulval Disorders"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Information<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Gynaecologists with a specialist interest in vulval disorders are available at SJH\/RIE. We are able to refer on to&nbsp; Dermatologists, Plastic Surgeons and Gastroenterologists (vulval Crohn\u2019s disease) etc. Every quarter there is a Scottish Vulval Multidisciplinary meeting which we can refer patients to, and attend, to discuss cases that require more specialised\/personalised treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Where cancer is not suspected, women with&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/vaginaldischarge-vulvitis\/\">vaginal discharge \/ vulvitis<\/a> should be referred to Chalmers.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"880\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vulval-Diseases-flow-chart-880x1024.png\" alt=\"Vulval Diseases flowchart\" class=\"wp-image-11369\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vulval-Diseases-flow-chart-880x1024.png 880w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vulval-Diseases-flow-chart-258x300.png 258w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vulval-Diseases-flow-chart-768x894.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vulval-Diseases-flow-chart-1320x1536.png 1320w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vulval-Diseases-flow-chart-1760x2048.png 1760w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vulval-Diseases-flow-chart-980x1140.png 980w\" sizes=\"auto, (max-width: 880px) 100vw, 880px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">nhs Lothian<\/span> flowchart copyright NHS Lothian<\/figcaption><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\"><strong>B.C. &amp; S.S. 04-07-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Primary and Secondary Care clinicians<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer<\/strong>:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Women with red flag symptoms:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Suspected Vulval Cancer<\/strong>: unexplained asymmetrical \/ ulcerated\/bleeding \/ painful lumps.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Suspected VIN<\/strong>: asymmetrical lesion with pallor\/erythema +\/- itch, particularly on a background of smoking and\/or abnormal smears.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pigmented, irregular lesion.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">(Refer via Sci G&gt;SJH or RIE&gt;Gynaecology&gt;LI Gynae Basic Sign Referral&gt;Priority USOC)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Unresponsive to treatment after at least 6-8 wks<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Women with Dermatoses where Primary Care management has been unsuccessful e.g. Lichen Sclerosus, Lichen Planus<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><strong><u>History and Examination<\/u><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Enquire about past history of skin disorders (Eczema, Psoriasis, mouth ulcers), Atopy, Autoimmune Conditions (e.g. thyroid disease, pernicious anaemia).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Investigations<\/u><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Consider FBC (exclude anaemia), TFTs, blood glucose, STI screen.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Main Presenting Symptom<\/u><\/strong>:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pain\/discomfort\/superficial dyspareunia<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Generalised<\/strong>: &nbsp;&nbsp;&nbsp; Consider ATROPHIC VAGINITIS, &nbsp;LICHEN PLANUS, VULVODYNIA<\/li>\n\n\n\n<li><strong>Localised<\/strong>: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; LICHEN PLANUS, HERPES SIMPLEX <a href=\"https:\/\/dermnetnz.org\/topics\/genital-herpes-images\" target=\"_blank\" rel=\"noreferrer noopener\">Genital herpes images | DermNet (dermnetnz.org)<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Itching<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Candidiasis \u2013 less common in postmenopausal women, avoid repeated treatments without proven Candida on swab<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">LICHEN SCLEROSUS <a href=\"https:\/\/dermnetnz.org\/topics\/vulval-lichen-sclerosus-images\" target=\"_blank\" rel=\"noreferrer noopener\">Vulval lichen sclerosus images | DermNet (dermnetnz.org)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ECZEMA\/ PSORIASIS <a href=\"https:\/\/dermnetnz.org\/topics\/genital-psoriasis-images\" target=\"_blank\" rel=\"noreferrer noopener\">Genital psoriasis images | DermNet (dermnetnz.org)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">LICHEN SIMPLEX<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CONTACT DERMATITIS<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u00b7 STI screening should be considered in all patients and vulvovaginal candidiasis <a href=\"https:\/\/dermnetnz.org\/topics\/vulvovaginal-candidiasis-images\" target=\"_blank\" rel=\"noreferrer noopener\">Vulvovaginal candidiasis images | DermNet (dermnetnz.org)<\/a> excluded if the patient presents with vulval itch.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>GENERAL ADVICE<\/strong> (for all conditions)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most women with a vulval disorder will benefit from advice on general care of the vulval skin and avoiding potential irritants.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Avoid soaps, shower gel, scrubs, bubble baths, deodorants, baby wipes or douches in the vulval area.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Washing with water only causes dry skin and makes itching worse. Use a soap substitute to clean the vulval area. Use a small amount of the ointment with water to wash skin. This prevents the skin from becoming dry and irritated as it would if soap or water alone was used. The cream\/ointment is safe to use frequently.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/formulary.nhs.scot\/east\/skin\/skin-conditions\/dermatitis-contact\/\" target=\"_blank\" rel=\"noreferrer noopener\">Formulary | Lothian Joint Formulary (nhs.scot)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Shower rather than bath if possible and clean the vulval area only once a day. Over cleaning can aggravate vulval symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Avoid using sponges or flannels to wash the vulva which can irritate the skin. Wash vulva with a soap substitute with a hand. Gently dab the vulval area dry with a soft towel or use a hairdryer on a cool setting held well away from the skin.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Wear loose-fitting silk or cotton underwear. Tight-fitting clothes such as tights, cycling shorts, leggings or tight jeans should be avoided, including Lycra. Wear loose-fitting trousers or skirts and replace tights with stockings. At home, patients may find it more comfortable to wear long skirts without underwear.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Sleep without underwear.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Avoid fabric conditioners and biological washing powders. Consider washing underwear separately in a non-biological washing powder\/gel.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Some over-the-counter creams including baby or nappy creams, herbal creams (e.g. tea tree oil, aloe vera) and \u2018thrush\u2019 treatments may include possible irritants. Stop using them if they seem to be making things worse.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Avoid antiseptic (as a cream or added to bath water) in the vulval area.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>EMOLLIENTS<\/strong> (for all conditions)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Emollients can be used as moisturisers throughout the day. Please be aware that creams contain more additives than ointments so opt to prescribe OINTMENTS. If symptoms get worse or do not improve, stop using.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/formulary.nhs.scot\/east\/skin\/skin-conditions\/eczema\/\" target=\"_blank\" rel=\"noreferrer noopener\">Formulary | Lothian Joint Formulary (nhs.scot)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 Using one of these moisturisers every day can help relieve symptoms. Even when asymptomatic, using a moisturiser helps to protect skin and can prevent flare-ups.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 It is important to find the moisturiser that works for the patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2022 If the skin is irritated, the emollient can be kept in the fridge and dabbed on to cool and soothe the skin.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>CLOBETASOL PROPRIONATE 0.05% OINTMENT<\/strong> (for diagnosed\/suspected Lichen Sclerosus and Lichen Planus only)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Clobetasol ointment should be used sparingly (this means a fingertip sized amount on large areas but on smaller isolated areas a garden-pea sized amount) to the inner vulva and\/or area around the anus. This ointment should not be used on other areas in the groin unless specifically directed by a medical professional.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Apply the ointment:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Morning and night for 1 month<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At night for 1 month<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Alternate nights for 1 month<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Then 1-2 times a week for maintenance.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 30g tube should last at least 6 months. This amount is very safe and should not cause adverse effects on the treated skin or elsewhere in the body. If symptoms return whilst on a maintenance treatment, the Clobetasol ointment can be used for a few extra nights to treat the flare-up and then try to reduce back to once weekly. It is normal to notice stinging for a few minutes after applying the ointment. However, if stinging in the area lasts for more than 1-2 hours after application, the patient may have been sensitised to one of the ingredients. An alternative should be used. Please note, sensitisation is more likely with creams rather than ointments due to the additional additives in the former.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Follow Up<\/strong><\/p>\n\n\n\n<ol style=\"list-style-type:1\" class=\"wp-block-list\">\n<li>GP review 4-6 wks after instigating initial therapy.<\/li>\n\n\n\n<li>Self directed monitoring using a handheld mirror approx. 3-4monthly \u2013 if any concerns to be reviewed by GP<\/li>\n\n\n\n<li>Patient to see GP if they can see or feel any new changes to the vulval skin.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Patients should be given a detailed explanation of their condition with particular emphasis on any long-term implications for their health.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">Patient information leaflets \/ professional information can be found at the sites below:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">www.bssvd.org (The British Society for the Study of Vulval Disease)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"http:\/\/www.bad.org.uk\" target=\"_blank\" rel=\"noreferrer noopener\">www.bad.org.uk<\/a> (British Association of Dermatologists)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"http:\/\/www.issvd.org\" target=\"_blank\" rel=\"noreferrer noopener\">www.issvd.org<\/a> (International Society for Study of Vulval diseases)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/vulvalpainsociety.org.uk\/\" data-type=\"link\" data-id=\"https:\/\/vulvalpainsociety.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/vulvalpainsociety.org.uk<\/a> (Vulval Pain Society)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">NZ Dermnet&nbsp; <a href=\"https:\/\/dermnetnz.org\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/dermnetnz.org<\/a> (<a href=\"https:\/\/dermnetnz.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">DermNet NZ \u2013 All about the skin | DermNet NZ<\/a>)- excellent Consultant Dermatologist written site on all Dermatology conditions incl vulval diseases.<\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Gynaecologists with a specialist interest in vulval disorders are available at SJH\/RIE. We are able to refer on to&nbsp; Dermatologists, Plastic Surgeons and Gastroenterologists (vulval Crohn&rsquo;s disease) etc. Every quarter there is a Scottish Vulval Multidisciplinary meeting which we can refer patients to, and attend, to discuss cases that require more specialised\/personalised treatment. Where<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3976,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[838],"class_list":["post-11367","page","type-page","status-publish","hentry","category-https-apps-testing28-scot-nhs-uk-refhelp-guidelines-vulval-disorders"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gynaecology\/https-apps-testing28-scot-nhs-uk-refhelp-guidelines-vulval-disorders\/\" rel=\"tag\">Vulval disorders<\/a>","rttpg_excerpt":"Information Gynaecologists with a specialist interest in vulval disorders are available at SJH\/RIE. We are able to refer on to&nbsp; Dermatologists, Plastic Surgeons and Gastroenterologists (vulval Crohn&rsquo;s disease) etc. Every quarter there is a Scottish Vulval Multidisciplinary meeting which we can refer patients to, and attend, to discuss cases that require more specialised\/personalised treatment. Where","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/11367","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=11367"}],"version-history":[{"count":16,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/11367\/revisions"}],"predecessor-version":[{"id":26917,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/11367\/revisions\/26917"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3976"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=11367"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=11367"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}