HNY Policy and Pathway Repository - North Yorkshire and York

Commonly present with pruritis and pain

*benign small cysts/lumps not causing symptoms do not require treatment or referral which includes Bartholin’s cysts.

Vulval ulceration or increasing lesion of vulval skin-refer Suspected Gynaecological Cancer 2WW fast track referral proforma

• Exclude vulval candidiasis
• Examine vulval, perianal area, vagina, cervix.
• Look for any evidence of systemic illness by examining rest of skin and oral mucosa
• Most common vulval disorders are:
  • Lichen sclerosus - for management see below
  • Atrophic vulvovaginitis
     

Investigations prior to referral

• Consider TFT/HbA1c 
• Swabs if clinical signs of infection

Indications for referral

• Lesions or conditions not responding to management below

Information to include in referral letter

• Description of vulva and any lesion
• Smear history
• Relevant past medical/surgical history
• Current regular medication
• BMI
• Smoking Status

Referral Criteria

• Lesions or conditions not responding to management above
• Detail treatments tried, duration, problems etc and results of suggested investigations

Patient information leaflets/ PDAs

• http://patient.info/health/vulval-problems-leaflet
• British Association of Dermatologists - Patient Information Leaflets (PILs) (bad.org.uk)
• Skin conditions of the vulva patient information leaflet (rcog.org.uk)

References

• British Association for Sexual Health and HIV BASHH- Guideline on Management of Vulval Conditions

• York and Scarborough Teaching Hospitals