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Vulval Skin Disorders, Management (Green-top Guideline No. 58)

Published: 22/02/2011

This is the first edition of this guideline.

Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

Symptoms and signs of vulval skin disorders are common and include pruritus, pain and changes in skin colour and texture. Community-based surveys indicate that about one-fifth of women have significant vulval symptoms. In the hospital setting, common causes are dermatitis, lichen simplex, vulval candidiasis, lichen sclerosus and lichen planus. Lichen sclerosus accounts for at least 25% of the women seen in dedicated vulval clinics, with estimates of incidence quoted as one in 300 to one in 1000 of all patients referred to dermatology departments.

This guideline aims to provide an evidence-based framework for improving the initial assessment and care of women with vulval disorders. This guidance is intended for the general gynaecologist, with advice on when to refer to the specialist multidisciplinary team as the most efficient link to other services, such as a patch test clinic, psychosexual counsellors or reconstructive surgeons.

Details of individual skin conditions can be found in Appendix 2. Advice on general care of the vulval skin can be found in Appendix 3 and on training in Appendix 4.