A groundbreaking study led by experts at the University of Nottingham has uncovered the key reasons why vulval lichen sclerosus (VLS), a skin condition affecting the external female genitalia and linked to an increased risk of cancer, is often under-diagnosed in general practice.
Published in the British Journal of General Practice, the study highlights that VLS, which affects up to 3% of women, is frequently diagnosed late due to challenges reported by clinicians. VLS causes intense itching, scarring, and can increase the risk of vulval cancer by up to 22 times. Fortunately, the condition can be effectively managed with a simple steroid ointment when diagnosed early, preventing long-term complications and improving quality of life.
Dr. Louise Clarke, a GP at the University’s Centre for Evidence-Based Dermatology and lead author of the study, explains:
“VLS is a painful, itchy, and often distressing condition that affects the vulva. Clinicians in primary care acknowledge that women encounter barriers to diagnosis, resulting in missed opportunities for early treatment. Improving diagnostic criteria, raising awareness, and educating both women and healthcare professionals are crucial to ensuring timely diagnosis and reducing long-term complications.”
To investigate the challenges surrounding VLS diagnosis, the research team surveyed GPs, GP trainees, and nurses across England. Of the 122 professionals who responded, nearly 40% reported receiving no education on vulval skin conditions, with many expressing a lack of confidence in diagnosing VLS. Male professionals, in particular, reported less experience and confidence in recognizing the condition.
The study also revealed that several other factors contribute to delays in diagnosis, including stigma around vulval conditions, embarrassment, lack of awareness among women about their own anatomy, and uncertainty among clinicians about which hospital specialty to refer patients to.
Dr. Rosalind Simpson, another author of the study, adds:
“Discussing VLS can be an uncomfortable and embarrassing topic for many women, which can deter them from seeking medical help. Even when they do seek care, barriers remain, leading to missed opportunities for diagnosis. Through better education for both women and healthcare professionals, we hope to facilitate earlier diagnosis and more timely treatment, ultimately reducing the long-term impact of this condition.”
