Vulval Disease Patient Information

Best Practices for Those Suffering from Vulval Symptoms

This information is pertinent for individuals experiencing vulval symptoms, whether it involves itching, soreness, or a burning sensation. Proper vulva care is a crucial component of managing all vulval conditions.

Important Principles

Steer clear of potential irritants.
Avoid excessive cleaning (once a day is ideal).
Refrain from scratching.
Maintain well-hydrated skin.
Follow your specialist's instructions for applying topical treatments.
Use an appropriate vaginal lubricant during intercourse as advised by your specialist.

Avoid Contact with Irritants

Refrain from using perfumed or soapy products.
Avoid the use of feminine or toilet wipes.
Opt for loose-fitting clothing over tight trousers or jeans.
Choose cotton underwear.
Avoid wearing pajamas and underwear while in bed.
Whenever possible, steer clear of panty liners or sanitary towels containing chemicals. When needed, select chemical-free options.
If experiencing urinary incontinence, seek appropriate treatment.

Avoid Excessive Cleaning

Numerous women experiencing vulval conditions may experience feelings of uncleanliness, leading them to excessively wash or douche. However, this habit can be counterproductive as it disrupts the natural bacterial balance of the skin, resulting in increased irritation. The best advice is to take a warm bath daily.

Try to Avoid Scratching!

It may sound simple, but scratching can exacerbate the issue by causing more soreness and damage to the skin. It's crucial to maintain short fingernails and avoid nail polish. If nighttime scratching is a concern, consider wearing cotton gloves to bed. Instead of scratching the vulva, try applying chilled moisturizer or ice wrapped in a thin cloth for relief.

Moisturise the Skin

This practice will contribute to skin conditioning, and it's recommended to apply moisturizer at least once a day. Your specialist will provide guidance on an appropriate emollient to use.

Follow your Specialist's Instructions for Applying Topical Treatments.

While the temptation to apply various treatments to the vulva can arise, it's often best to keep it simple. Your specialist may prescribe a specific ointment, and it's crucial to adhere to their instructions for application. Medications will be assessed during each appointment.

Use Lubricant During Sexual Intercourse as Advised by your Specialist

Individuals with a vulval condition frequently discover that it can also affect their ability to engage in sexual intercourse. Arousal, in particular, may be compromised, especially when a woman experiences pain during sex. Using a natural, water-based lubricant is recommended, and your specialist can provide further information on this topic.

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Lichen Planus Patient Information

Lichen planus (LP) is an inflammatory condition that can affect women of all ages, with a higher prevalence observed after menopause. This inflammatory process can manifest on various parts of the body, including the vulva, vagina, mouth, or other areas of the skin. While the exact cause of LP remains unclear, it is believed to be related to an autoimmune response, where the body's immune system mistakenly attacks its own tissues. Importantly, LP is neither infectious nor contagious.

Common Symptoms of Lichen Planus

Soreness of the vulval skin
Raw, damaged appearance of the skin
Pain during intercourse
Persistent vaginal discharge (which may sometimes be bloody)
Alterations in vulva appearance, such as the loss of labia minora (vulval lips) and flattening of the clitoral hood
Vaginal blockage leading to discomfort during sexual activity or smear tests
Vulval itching

Diagnosis

Typically, the diagnosis of LP can be made by gathering your medical history and conducting a thorough examination by a vulval specialist. In some cases, a small skin biopsy may be necessary to confirm the diagnosis.

Treatment

LP is a chronic condition without a cure, but treatment focuses on managing symptoms and preventing further inflammation. The progression of LP can vary among individuals, with symptoms occasionally subsiding or even disappearing over time. The primary treatment involves the application of steroid ointments to the affected skin and the use of vaginal steroid preparations. It is crucial to avoid irritants such as soapy or perfumed products in the vulval area, and daily moisturizing can enhance skin quality. If managing LP becomes challenging, steroid tablets or medications to suppress the immune system may be considered. When the vaginal area is affected, treatment options may include vaginal dilators and specialized physiotherapy. Surgery is rarely recommended for LP management, and when required, it typically involves addressing scar tissue within the vagina.

Follow-up

Your specialist will regularly monitor your condition until your symptoms are well managed. It's important to note that women with LP have a slightly increased (3%) risk of developing vulva cancer. For this reason, long-term surveillance, typically every 6 to 12 months, is necessary to ensure your ongoing health and well-being.

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Lichen Sclerosis Patient Information

Lichen sclerosis (LS) is an inflammatory skin condition primarily affecting the skin around the vulva and anal area. While it can manifest at any age, it is most commonly observed after menopause. The exact cause of LS remains unknown, and it is not an infectious condition, nor can it be transmitted to others. There is a prevailing belief that LS may be related to an autoimmune response, where the body's immune system mistakenly targets its own tissues.

Common Symptoms

Itching of the skin surrounding the vaginal and anal openings
Skin soreness, particularly during urination
Changes in skin color, which may appear white or red
Alterations in the appearance of the vulva, including the shrinking and flattening of the labia minora (vulval lips) or the clitoral hood, along with potential narrowing of the vaginal opening
Discomfort during intercourse

Diagnosis

Typically, a specialist in the clinic can diagnose LS by taking your medical history and conducting a thorough vulvar examination. In rare cases, a skin biopsy may be performed to confirm the diagnosis.

Treatment

LS is a chronic condition without a cure, and treatment focuses on managing symptoms and preserving normal tissue structure to the extent possible. Steroid ointments are highly effective in alleviating or reducing itching. Moisturizing the skin is crucial, and it is essential to avoid using soapy or perfumed products on the vulva. Surgical intervention is uncommon in LS treatment. However, it may be considered primarily to widen the vaginal opening, which can improve discomfort during intercourse or difficulties with urination.

Follow-up

If you receive a diagnosis of LS, your specialist will want to see you regularly until your symptoms are well managed. Long-term follow-up is recommended for individuals with LS due to a small associated risk (3-5%) of developing skin cancer. Typically, annual check-ups are advised as a minimum precautionary measure.

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Bleeding After Sex

Experiencing bleeding after sexual intercourse is a fairly common occurrence, and it can be attributed to various underlying causes. If you have been dealing with this issue for more than three months, it is advisable to seek consultation with a specialist. The severity of bleeding can vary, ranging from mild spotting to a more substantial bleeding resembling a menstrual period.

Common Causes

Pelvic Infection: Especially when accompanied by pain and unusual discharge. Undergoing an STI screening is recommended in cases of bleeding during sex.
Ectropion: This is a common finding on the cervix, characterized by the presence of glandular cells from the inner cervical canal migrating to the outer cervix. These delicate glandular cells tend to bleed upon contact, often due to friction with the penis during intercourse. Ectropion may not always require treatment, but if symptoms are bothersome, the cells can be removed or treated with a minor procedure involving local anesthesia.
Post-Menopausal Changes: In women post-menopause, vaginal tissues can become dry and atrophic due to decreased estrogen levels. This can result in bleeding during sex. Applying estrogen locally in the vagina or using a vaginal moisturizer can be effective in addressing this issue.
Benign Polyps: These fleshy growths are a common discovery on the cervix and can bleed upon contact. They are typically easily removed during a clinic visit.
Contraceptives: Some contraceptive methods can lead to bleeding during intercourse.

Cervical Cancer

It's crucial to recognize that bleeding after sex can also serve as a potential indicator of cervical cancer, and thus, it should always be investigated thoroughly. However, it's worth noting that cervical cancer is relatively rare in the UK, with approximately nine cases per 100,000 women, and post-coital bleeding is a frequent symptom. Regular cervical screening, such as smear tests, plays a pivotal role in preventing cervical cancer, significantly reducing the associated risks.

If you are experiencing bleeding after sex, it is advisable to consult with a specialist to rule out serious underlying causes, including cervical cancer. A detailed colposcopy examination of the cervix will be conducted, involving a thorough microscopic assessment.

Treatment for bleeding during sex is tailored to individual circumstances, contingent on the cause of the bleeding and the level of discomfort or distress it causes.

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Pre-cancer of the Vulva (VIN)

Cancer of the vulva is a rare occurrence. However, before cancer develops, there is a precancerous phase formerly known as VIN (Vulval Intraepithelial Neoplasia). The official term for this condition has now been updated to High-grade Squamous Intraepithelial Lesion (HSIL) of the vulva. Our primary goal is to diagnose and treat vulval pre-cancer before it progresses to cancer.

Some vulval cancers are linked to chronic inflammatory conditions like lichen sclerosis or lichen planus. Therefore, if you have one of these conditions, it is essential to have regular follow-up appointments with your specialist. Other vulval cancers are caused by the Human Papilloma Virus (HPV), the same virus responsible for cervical pre-cancer and cancer. Regular cervical checks are crucial if you have vulval pre-cancer. Prolonged HPV activity in the body increases the risk of pre-cancerous changes. Notably, smokers and individuals with compromised immune systems (e.g., transplant recipients or those taking immune-suppressing medications like methotrexate) are more likely to have persistent infections.

Common Symptoms

Pre-cancer of the vulva can manifest in various ways. Patients often notice lumps or bumps on the vulval skin, which may resemble warts. There is usually a change in color, ranging from red, white, brown, to black. Many patients also experience vulval soreness, and occasionally, itching.

Diagnosis

The presence of pre-cancerous lesions can be determined through a vulvar examination. In some cases, a microscope is used for a detailed assessment called vulvoscopy. If your specialist suspects vulval pre-cancer, a biopsy (small tissue sample) is obtained to confirm the diagnosis. This biopsy is typically performed in the clinic under local anesthesia.

Treatment

Treatment options for vulval pre-cancer include surgical and medical approaches.

Surgery is the preferred method and typically involves the removal of the affected tissue. This procedure is performed as a day case in a surgical setting under general anesthesia. Dissolvable sutures are used to close the incision. Occasionally, heat or laser treatments are employed for disease management.

Medical treatment using a medication called Imiquimod (off-label use) can stimulate the local immune system when applied to the lesion. Common side effects include a burning sensation, redness, and irritation. Treatment duration is usually up to four months, guided by your specialist.

Treatment planning takes various factors into account, and your specialist will customize the approach to your specific needs and circumstances. It is strongly recommended that all women with vulval pre-cancer cease smoking, as this significantly enhances the chances of preventing recurrence.

Recurrence

Recurrence of vulval pre-cancer is not uncommon. Even after successful treatment, continued surveillance is necessary. If you have a history of recurrent vulval pre-cancer, you will likely require ongoing specialist follow-up. Quitting smoking can substantially reduce the risk of recurrence.

Follow-up

After treatment, anticipate regular follow-up appointments with your specialist every three to six months initially. If there are no signs of recurrence, follow-up appointments may transition to an annual basis.

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Vulvodynia Patient Information

Vulvodynia is a distressing pain syndrome characterized by burning discomfort in the vulva that persists for at least three months. Notably, there are no observable abnormalities upon examination. This condition arises from heightened sensitivity of the nerve fibers in the vulvar skin, causing them to transmit abnormal pain signals to the brain.

Despite being a common condition, many women hesitate to discuss it due to embarrassment, often delaying seeking medical assistance. The exact reasons why some women develop vulvodynia while others do not remain unclear. Some theorize that an initial irritation from a thrush infection may trigger the condition. Importantly, vulvodynia is neither infectious nor contagious, meaning it cannot be transmitted to others. The prognosis for vulvodynia varies widely; some women experience spontaneous symptom improvement over time, while others endure symptoms for many years. Nevertheless, most women can achieve some level of symptom control with appropriate treatment.

Vulvodynia is categorized based on when symptoms occur. Provoked Vulvodynia refers to pain experienced only upon vulvar contact, such as during intercourse, bike riding, or tampon insertion. In contrast, Unprovoked Vulvodynia involves persistent or sporadic symptoms without specific triggers.

Common Symptoms

Burning and soreness anywhere on the vulva
Pain during intercourse, often making sexual activity impossible
Pain during smear tests

Diagnosis

Diagnosing vulvodynia relies on a comprehensive patient history and a thorough clinical examination. There are no specific diagnostic tests for this condition.

Treatment

Vulvodynia is a complex condition best managed by a vulval disease specialist. Treatment typically involves a combination of therapies tailored to whether the patient has Provoked or Unprovoked Vulvodynia. The primary treatment goals are pain control and achieving pain-free intercourse.

Common Treatment Approaches Include:

Topical anesthetic treatments
Specialized physiotherapy
Medications (oral or topical) aimed at reducing abnormal nerve impulses
Steroid injections
Psychosexual therapy
Water-based vaginal lubricants
Vaginal dilator therapy
Cognitive Behavioral Therapy
Acupuncture
Surgery (vestibulectomy): This procedure is only offered to select patients who meet specific criteria and is primarily used to treat Provoked Vulvodynia. However, it carries the potential risk of worsening symptoms, and its suitability is determined on an individual basis by your specialist.

Follow-up

The management of vulvodynia is highly individualized, with follow-up care tailored to each patient's unique circumstances and needs.

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Best Practices for Those Suffering from Vulval Symptoms

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Lichen Planus Patient Information

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Lichen Sclerosis Patient Information

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Bleeding After Sex

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Pre-cancer of the Vulva (VIN)

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Vulvodynia Patient Information

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Clinic locations

The Priory Hospital

The Vesey Private Hospital

The Edgbaston Hospital

The Harborne Hospital