Audit of a multidisciplinary vulvar clinic in a gynecologic hospital

OBJECTIVE: To perform a five-year retrospective audit of all new patients r eferred to a tertiary vulvar referral service. STUDY DESIGN: A review was made of the records of all new clients who atten ded 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 pruritis (44.8%), soreness (28.6%) and irritation (24.3%). Striking feature s were the poorly defined and lengthy histories and multiple symptomatology . Biopsies were performed in 61% of cases. Histological diagnoses included vulvar intraepithelial neoplasia (VIN), 18.5%; nonneoplastic epithelial dis orders, 16.8%; and carcinoma, 8.1%. Clinical diagnoses included dermatitis in 10% and normal vulva in 7.7%. The remaining cases represented a wide var iety of dermatologic, pain and gynecologic conditions. There was a 95% corr elation between the clinical and histologic diagnosis of VIN and 87% in lic hen sclerosus. In 64.7% of women, treatment resulted in an improved outcome , 13.7% reported no improvement, and 1.6% cases deteriorated during treatme nt; 19.9% were lost to follow-up. CONCLUSION: Provision of a multidisciplinary vulvar clinic in a tertiary se tting provides an invaluable service for both primary and secondary clinica l 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 con sequence of the interests of the clinicians involved.