Report from the Newcastle Vulval Pain Society workshop held at the Royal Victoria Infirmary, 17 January 2009

The North East was our destination for the 17th VPS workshop. On a cold, frosty Friday Kay and I ventured up to Newcastle at the invitation of Drs Janet McLelland and Jane Hussey. Dr McLelland is a Consultant Dermatologist working at the Royal Victoria Infirmary and has had a long interest in vulval disease, especially vulval dermatology. She runs a twice-a-week genital skin clinic which includes many patients with vulval problems. This is one of many multidisciplinary clinics in the UK. She works with Dr Jane Hussey, a Consultant in Genitourinary Medicine at a GUM clinic in Northumberland so that both doctors can give different perspectives on complex vulval problems. They were kind enough to give us accommodation for the day (and also put us up for the night).

There were 18 women and partners who attended along with other local health professionals. We usually advertise the day via the internet, by letter from our database, by contacting local GUM clinics and through flyers in the hospital department. Some women attending were newly diagnosed with vulvodynia and some had had longstanding problems. I am always amazed by the power of the internet, as some women had come from Scotland, London and North Wales, to gain information and to explore their treatment options. I gave an informal talk on vulval anatomy and common conditions as well as a more in-depth talk on vulvodynia management and treatment options. Common themes come up at workshops: how to apply creams, how to take drugs for pain, managing side-effects.

There is a general feeling in the medical community that the way forward to getting effective care for vulvodynia is to have a team approach from different practitioners. There are many treatment options in vulval pain and most doctors work inside their own comfort zone. If a treatment is not within the remit of one health professional then he/she should refer on (e.g. a gynaecologist is unlikely to be able to give a course of psychosexual counselling and a psychosexual counsellor is unlikely to examine a patient).

The different practitioners that might be involved with pain management are:

1) Gynaecologist; GP; dermatologist; genitourinary medicine physician - to assess and diagnose vulval problems and prescribe treatment
2) Physiotherapist - for assessment of the pelvic floor muscles and desensitisation/massage of the area
3) Psychosexual counsellor - for structured sex therapy for patients and partners
4) Pain management team (anaesthetist, pain management nurses and sometimes an acupuncturist) - for the management of severe pain.

Depending on your own individual condition it may be necessary to involve these different practitioners. GUM clinics are open access and you don't need a referral, plus you can be seen out of your area if you prefer.

Dr McLelland and Dr Hussey are keen to develop a team approach to vulvodynia management and are currently working with local physiotherapists and pain clinics to provide such a service. They are happy to take referrals from the area and if you have vulval pain and need to be seen you could ask your doctor for a referral to the service.

David Nunns