A retrospective study of the referral patterns to a vulval clinic: highlighting educational needs in this subspecialty

Abstract

A retrospective study of the referral patterns to a specialist vulval clinic was performed. A total of 200 clinical records were reviewed of new patients seen between January 2004 and June 2005. A provisional diagnosis was stated in 45.5% of referrals, of which 27.5% had the diagnosis changed at the clinic. The majority of referrals were from general practitioners (GPs) (77%) and smaller proportions from gynaecologists (11%), dermatologists (9%) and others (3%). The most common conditions seen were lichen sclerosus (39%), eczema/lichen simplex (30.5%), lichen planus (11.5%), pain syndromes (10.5%) and others (8.5%). Lichen sclerosus was accurately diagnosed in 54.5% of referrals but for eczema/lichen simplex it was only recognised in 11.5% of referrals. Nine cases of lichen sclerosus had been referred by gynaecologists after histological confirmation, for advice on management. Education of vulval diseases to non-specialists should focus on conditions that they are most likely to encounter and find difficult to manage. This study illustrates an effective method to define what the local teaching requirements are.

Lichen simplex chronicus of anogenital region: A clinico-etiological study

“…The prevalence of AGLSC was about 0.5% in the general population of the western Europe and America, [1] 10% in a study in a multidisciplinary vulvar clinic, [3] 30.5% in a specialist referral vulvar clinic [4] and 35% among non-neoplastic vulvar biopsies. [5] In our study, the frequency of AGLSC among patients attending the Dermatology OPD was 1.44 per 1000 population.…”

Les dermatoses génitales: profil épidémiologique et clinique

“…La localisation des dermatoses génitales chez les femmes prédominent au niveau des grandes et petites lèvres dans notre série ce qui rejoint l’étude indienne à propos de 120 patients avec un pourcentage de 92% au niveau des grandes lèvres et 48% au niveau des petites lèvres [2]. Les dermatoses génitales retrouvées chez les femmes dans notre étude sont prédominées par les dermatoses d'origine virale suivie par le vitiligo puis l'origine mycosique, cela n'est pas le cas dans la littérature où elles sont prédominées par le lichen scléreux suivi par le vitiligo puis l'origine mycosique et les autres étiologies [2, 6, 7]. …”

Non venereal benign dermatoses of vulva in sexually active women: a clinical study

“…These finding were comparable to a similar study conducted by Deeptara Pathak et al 6 The commonest presenting complaint in our study was vulvar itching (60%) which was in concordance with other studies except for a study conducted by Harlow et al who found vulvar pain to be the commonest presenting symptom seen in nearly 12% of patients followed by itching and burning in 6.6% of patients. [6][7][8][9] The most common group of vulvar dermatoses noted in our study was infections and infestations seen in 50 patients (71.42%), followed by inflammatory dermatoses in 20%, benign tumors and cysts in 5.7%. The incidence of these dermatoses was similar to that observed in a study conducted in Nepal but was in contrast to the study…”

“…Our finding is in contrast to studies quoted in western literature where lichen sclerosus et atrophicus was the most most frequently observed vulvar dermatoses. 8,11,12 The reason for this variation could be due to the age group of patients in our study which mainly comprised of women of reproductive age group, while it has been mentioned in medical literature that LSA has two peak ages of presentation: prepubertal and post-menopausal. A study of 350 women with LSA by Thomas et al showed that the mean age of patients was 56 years.…”

“…13 In a retrospective study conducted by Cheung et al the most common vulvar conditions that were noted were lichen sclerosus (39%), lichen simplex (30.5%), lichen planus (11.5%) and vulvar pain syndromes (10.5%) followed by other dermatoses. 8 Similarly Fischer et al conducted a prospective study of 141 patients with vulvar complaints and the most common vulvar dermatoses noted were lichen sclerosus (13%), vulvovaginal candidiasis (10%), vulvodynia (9%) and psoriasis (5%). 12 The approach to patients with vulvar disorders varies from country to country.…”