Audit of a multidisciplinary vulvar clinic in a gynecologic hospital

OBJECTIVE: To perform a five-year retrospective audit of all new patients referred to a tertiary vulvar referral service. STUDY DESIGN: A review was made of the records of all new clients who attended the vulvar clinic between 1993 and 1997. Information was entered into a database and analyzed. RESULTS: Four hundred seventeen women were seen in the study period. Their ages ranged from 8 to 94 years (mean, 48.5). The most common symptoms were pruritus (44.8%), soreness (28.6%) and irritation (24.2%). Striking features were the poorly defined and lengthy histories and multiple symptomatology. Biopsies were performed in 61% of cases. Histologic diagnoses included vulvar intraepithelial neoplasia (VIN), 18.5%; nonneoplastic epithelial disorders, 16.8%; and carcinoma, 8.1%. Clinical diagnoses included dermatitis in 10% and normal vulva in 7.7%. The remaining cases represented a wide variety of dermatologic, pain and gynecologic conditions. There was a 95% correlation between the clinical and histologic diagnosis of VIN and 87% in lichen sclerosus. In 64.7% of women, treatment resulted in an improved outcome, 13.7% reported no improvement, and 1.6% cases deteriorated during treatment; 19.9% were lost to follow-up. CONCLUSION: Provision of a multidisciplinary vulvar clinic in a tertiary setting provides an invaluable service for both primary and secondary clinical practitioners. The increasing demand for our services has created lengthy waiting times. The chronic nature of many vulvar diseases results in long-term follow-up of many women. Patient selection bias has developed as a consequence of the interests of the clinicians involved.