Report from Belfast Vulval Pain Society Workshop held at Belfast City Hospital, 1 September 2007

The Vulval Pain Society held a workshop at the invitation of Sonia Hutchinson, a dermatologist from Belfast. Seventeen women attended on the day and these were patients from Sonia's practice, plus women in the area whom we had approached through our database and women reading about the day on the internet. I gave a standard lecture on managing vulval problems and getting a diagnosis, and discussed vulvodynia and lichen sclerosus. Although the two conditions are very different there is a considerable overlap as concerns the impact on the individual. There was generally a lively discussion about different treatments. In the afternoon we had a very informal session where people could ask questions.

For me the highlight of the day was the interaction between the health professionals who had attended (doctors and nurses) and patients themselves; there were clear failings in communication issues between us as the health professionals and patients in terms of reassurance about treatments and instructing patients how to treat themselves. For example, there were still concerns about the use of steroid ointments on the vulva as in lichen sclerosus and about the side-effects of taking tablets such as amitriptyline and gabapentin, which are usually prescribed for vulvodynia.

There is still a huge amount of work to be done in terms of awareness, not only in the hospital setting, but amongst general practitioners and nurses. I have personally learnt that as a doctor I need to really stress the importance of telling patients how to take their treatment because if patients are unsure they generally stop the treatment. I feel that sometimes patients do not give the treatment the opportunity to work.

Many issues were discussed and many women shared their concerns of isolation and frustration particularly prior to a diagnosis. Sexual issues and difficulties were mentioned, in particular, tightening of the lower vaginal muscles, which can lead to painful sex; this was the case for both lichen sclerosus and vulvodynia. Many of the women with lichen sclerosus were clearly worried about the risks of cancer in the vulval skin; this risk, we believe, is very low, certainly lower than 5%. Self-examination was stressed as being extremely important.

I thought that the day was very enjoyable and informal and would encourage any woman reading this who wants more information to come along on one of these days, as the day is predominantly for women rather than for the health professionals.

Keep an eye on the website for future dates.

David Nunns
Consultant Gynaecologist