title: A multidisciplinary vulva clinic: the role of genito-urinary medicine.
abstract: OBJECTIVE
  To characterise the new patient referrals to a combined vulva clinic and to assess the role of genitourinary services within the clinic.
  
  
  METHODS
  A case note review of all new patients attending a monthly, multidisciplinary vulva clinic over a 12-month period.
  
  
  RESULTS
  The mean age of the 135 women was 43 years (range 18-86 years). The majority of patients, 64 (47%), were referred by their general practitioner (GP). Using nurse and physician triage 85 (63%) patients were seen by a dermatologist, 55 (41%) by a genitourinary medicine physician, 38 (28%) by a gynaecologist and six (4%) by a psychosexual physician. Fifty-one (38%) women required a consultation by at least two specialties. Itch was the most frequent presenting symptom (70%) and 59 (44%) women had experienced symptoms for between 6 months and 2 years. A previous STD screen had been performed in only 57 (42%), which was negative in 45 (79%). The most frequent initial clinical diagnoses were lichen sclerosus (35, 26%), vaginal candidiasis (21, 16%), vulvodynia (16, 12%), lichen simplex chronicus (13, 10%) and Bowenoid papulosis (13, 10%). Thirty-eight (28%) women had microbiological investigations revealing 13/135 (10%) had vaginal candidiasis and two (2%) bacterial vaginosis, all symptomatic. A biopsy was performed in 32 (24%) confirming the initial diagnosis in 20 (63%) cases. Treatment was initiated in 101 (75%) women: 62 (46%) were prescribed steroid cream, 46 (34%) emollient cream and 22 (16%) treatment for candida infection. Fifty-three (39%) women received more than one treatment. 94 (70%) patients were followed-up in the vulval clinic, five (4%) in the genitourinary clinic and 12 (9%) by their GP.
  
  
  CONCLUSIONS
  Despite having genitourinary symptoms less than half the patients had been tested for infection prior to attending the clinic. More than a third of the patients, 46 (34%), were diagnosed with a genitourinary infection. There is a significant role for genitourinary services in the diagnosis, management and ongoing care of patients in a vulva clinic.
authors.affiliation: St. Stephen's Centre, Department of HIV GU Medicine, The Chelsea and Westminster Hospital, London, UK. anns@crusaid-star.co.uk
authors.forename: A K
authors.initials: AK
authors.lastname: Sullivan
authors.forename: G J
authors.initials: GJ
authors.lastname: Straughair
authors.forename: R P
authors.initials: RP
authors.lastname: Marwood
authors.forename: R C
authors.initials: RC
authors.lastname: Staughton
authors.forename: S E
authors.initials: SE
authors.lastname: Barton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis* / Q000628:therapy; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D016730:Program Development; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006113:United Kingdom; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000628:therapy