Introduction
Vulval disease has long been a neglected area of research in medicine, resulting in the absence of even basic data such as estimates of disease prevalence. Additionally, it is common for affected individuals to delay seeking medical advice through fear and embarrassment.
Current deficiencies in training (1) lead to failure of medical professionals to fully explore vulval symptoms. Women may present to a range of different specialties and making the correct diagnosis may take considerable time. There are unmet training needs for some gynaecologists in the assessment and management of vulval disease including the chronic pain and psychosexual issues that commonly arise so it is important to assess patients and refer difficult patients and non-responders on to a vulval service for a multidisciplinary opinion. Inappropriate treatment is not uncommon.Survey-based studies indicate that vulval disease is much more prevalent than once thought. In a survey of 79 United Kingdom general practitioners, over half saw more than three patients with vulval disease per month (2) and a United States-based community survey of 303 women reported 18.5% having lower genital tract discomfort lasting longer than 3 months (3).
Vulval disease is important as it causes considerable distress and can affect both physical and psychological and psychosexual well-being (4, 5). Furthermore, certain inflammatory vulval conditions have potential for progression to malignancy. Vulval disease is common in gynaecological practice. This chapter is aimed at the general gynaecologist to enhance knowledge and clinical skills in patient assessment, vulval examination, and treatment.