Women's Health Articles

When did you first become interested in dermatology? Why?

Back in the day, after my baby was born, I needed to work part time just for a short while.  Dermatology at that time had the funding to employ part-time medical professionals. So, I chose dermatology and thought it was great, it completely captured my interest. Working in dermatology, you can make people's lives an awful lot better by making use of just a little bit of knowledge. I can help patients so much in primary care without needing to forward them into secondary care for more expensive investigations and treatment. Dermatology isn’t always a priority subject on medical school curriculums and we need more qualified interested clinicians in primary care.

Why is it so important for you to highlight vulval skin conditions in your work?

Women can really suffer with vulval skin conditions and they often feel too embarrassed to say anything or try to get help. Women think that their mother had the same problems or that they are a result of the menopause, and it is the way it has to be because these conditions are a natural consequence of aging. Until we are all more open about these things and realise our vulvas are just another body part that your GP or nurse is happy to discuss, women are never going to feel empowered to talk about the problems that they might be having.

Do you think that this area of skin health is neglected within healthcare? Why?

In my day-to-day practice, I see women neglecting themselves more than GPs neglect their problems. In addition, doing a decent vulval consultation with a thorough examination takes time, and that is a thing that lots of GPs don’t have, especially at the moment. This pressure of time and a patient’s reticence to come forward makes it harder for doctors to investigate properly. This is before we factor in the shift to virtual consultations during the pandemic. All in all, vulval conditions do not get the time or space they deserve in the GP’s surgery. 

What are the most common vulval skin conditions? What are they caused by?

In today’s highly sanitised world where a daily shower is the norm for most people, rather than a weekly bath, personal hygiene is very high on the agenda. To achieve their desired level of cleanliness and a lack of bodily odour, women are using very hot water, soap, scented shower gel, scented Tampax or sanitary towels. None of these are appropriate for vulval skin. The most common and underrated thing that I see is vulval eczema, often caused by overuse of some sort of irritant or allergen. Genital (flexural) psoriasis is another condition that is very common but underdiagnosed because people think that it is a fungal infection.

How can we get those conditions diagnosed?

Well, in the UK you cannot see any secondary care consultant without a referral from your GP, so primary care is always going to be your first port of call. That said, there is then a decision to be made whether to see a dermatologist, or a gynaecologist.  I am very lucky in Liverpool because there is a joint vulval clinic run by both of them together.  I would however argue that you are better off going down the dermatology route than the gynae route, if you consider that it is a skin problem on the vulva, rather than an actual vulval problem. Of course, as a dermatology specialist GP – I would say that!

Why are women going through menopause more likely to get a skin condition down below?

Women who are going through menopause are more at risk of vulval skin conditions because of the drop in oestrogen that occurs at that time. It is oestrogen that keeps the vulval skin and tissues soft, moist and hydrated. When oestrogen drops, this skin becomes thinner, and more likely to split. The normal levels of bacterial in the skin changes too, as does the pH. These things are normal but there is a lot that can be done to help the skin repair itself. Regular use of emollient, using topical steroids if needed for inflammation and itch, and considering topical or systemic HRT are all potential treatment avenues to explore. 

How easy are these problems to treat? Do you have to use steroids?

There are some conditions like lichen sclerosis where you absolutely must use steroids to prevent disease progression. Vulval skin is surprisingly robust, and you can use steroids sparingly but consistently for most of your life in order to control certain conditions. When you move down the scale to the less complex conditions like vulval eczema, or lichen simplex, you might use steroids initially to beat the ‘itch, scratch, itch’ cycle but a good emollient is often enough moving forward. But the first step usually is to ensure that the patient understands how the condition came about and what they themselves can do to help.

Ladies! If you need so extra support for your health, our women’s health hub is always open and jam-packed full of great resources!