Gynaecological conditions – benign vulval conditions and FGM

Vulval cancer should be considered in any woman with persistent vulval symptoms, particularly when there is one area which does not respond to topical treatment, or which appears red, white or ulcerated. If there is any concern about malignancy, the patient should be referred for consideration of a biopsy. Idiopathic pruritus vulvae is unusual; an underlying cause can usually be found. Some women will have an inflammatory dermatosis such as lichen sclerosus, lichen planus or lichen simplex, which can cause long-term scarring if not appropriately managed. The vulva may also be affected by systemic skin diseases such as psoriasis. Vulvodynia is defined as ‘vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurologic disorder’ and can be difficult to manage, often requiring a multi-disciplinary approach which addresses both physical and psychological aspects.

Female genital mutilation (FGM) is a term used to describe a variety of procedures in which some or all of the female external genitalia is removed, for non-medical reasons, usually in infancy or childhood. Synonyms used in cultures where FGM is prevalent include female circumcision, initiation, sunna, gudniin, halalys, tahur, megrez, khitan and infibulation. It is illegal for an adult to subject a child to FGM in the UK, or to plan to take a child out of the UK for the purposes of FGM; healthcare professionals have a mandatory duty to report any FGM in girls aged under 18 and we should also be alert to softer signs that a girl may be at risk of FGM. These include a family history of FGM in the mother or an older sister, being aware of plans to take a girl to a high-risk country for FGM, or a girl from a culture that practices FGM talking about a long holiday or plans for a ‘special celebration’ to do with ‘becoming a woman’. Police or social services referral is not mandatory for adults with FGM, but a risk assessment should be undertaken using an approved tool – if a risk to the woman’s children is identified then appropriate reporting should be carried out.

Adults may present with a request for repair of FGM done in childhood, or it may be identified opportunistically during a gynaecological examination or a (possibly unsuccessful) attempt to take a smear test. Referral should be made to a clinic with expertise in this area, who may carry out de-infibulation. Screening for hepatitis B/C and HIV is also advised.

More information can be found in the following resources: