Diagnosis, referrals, check-ups and support

Who should I go to if I have LS symptoms?

If something’s not right, don’t ignore it. Make an appointment with a healthcare professional and talk it through. Most people with LS symptoms go to their local GP or practice nurse, but a sexual health clinic may be able to help too.

You could also make an appointment with a private health professional. If you do, check their details beforehand to make sure you’re confident they specialise in this area. The British Society for the Study of Vulval Disease (BSSVD) has a list of experts in vulval skin disorders you can check (opens in new tab).

The most important thing is that the person you go to listens and tries to help, whether that’s by making a diagnosis themselves, or referring you on to a specialist.

For more information see our diagram and video about the anatomy of the vulva.

Can I see a pharmacist?

You can, but there’s only so much they can do to help. While they should be able to recommend products to wash and moisturise with, or advise on vulval care, they won’t be able to examine or diagnose you. They also won’t be able to give you the topical corticosteroid ointment you need, because it’s only available on prescription.

So, if you think you might have LS, it’s always best to make an appointment with your GP, who should be able to give you a proper diagnosis, recommend the right treatment or, if need be, refer you to a specialist.

What if I’m struggling to talk about my symptoms?

We know it might feel uncomfortable talking about your symptoms, or using the correct anatomical words for the vulva, but it’s really important to be as specific as you can when you talk to your doctor.

You could write down the affected areas and show the list to your doctor if you’re struggling to say them out loud. Or you could take along our printable vulva diagram and point them out.

We’ve also put together a checklist of vulval LS signs and symptoms to help you explain what you’re concerned about. If you like, you can print it out and take it along to your appointment.

If you’ve self-treated for thrush but your symptoms haven’t improved, make sure you let your doctor know.

How will the doctor diagnose me?

To diagnose LS, your doctor will need to examine you. It’s the only way to be certain about a diagnosis, and to make sure you get the treatment you need.

So, go to the appointment prepared for this to happen and make sure your doctor knows that’s what you expect. Sometimes health professionals are hesitant because they’re worried their patients will be uncomfortable, so you might need to ask them to examine you.

If it helps you feel more comfortable, you can bring a chaperone: someone to be there with you during the examination. You may request a chaperone at the surgery or when you book your appointment and a female colleague will stay in the room with you while they examine you.

Sometimes people need a biopsy to confirm their LS diagnosis. If your doctor says you need one, you can find out what to expect in our biopsy information.

What can I do if I think I’ve been misdiagnosed?

We know that LS is often misdiagnosed, most commonly as thrush (a yeast infection) or as a symptom of menopause. That’s why it’s so important to have an examination.

There are some key signs of LS which you wouldn’t get with thrush or the menopause, so if you notice them, tell your doctor and, if necessary, ask them to examine you again. These signs often (but not always) include changes to the colour of your skin and persistent itching. But you might also experience:

• Extremely intense itching
• Itching in your bottom or the area between your vagina and bottom
• Taking thrush treatment and finding it hasn’t helped
• Bleeding and tearing of fragile skin when you have sex or exercise
• Changes to the shape of your vulva, for example if the skin has started to fuse together or you can’t clearly make out the distinct parts of the vulva
• No signs of thrush-like discharge (or discharge that’s unusual for you)

If you think you’ve been misdiagnosed, book another appointment and make sure you mention these signs. You could share our information for healthcare professionals with them.

What can I do if my GP doesn’t give me the care I need?

If you’ve seen a GP but you haven’t been given treatment that helps, ask reception for a face-to-face appointment with a GP who is confident in women’s healthcare. If this isn’t available at your surgery, you could try your local sexual health or genitourinary medicine clinic.

Take our checklist with you and explain why you think you might have LS.

If I’ve got an LS diagnosis but I’m struggling, who can help?

If you’ve been diagnosed with LS and you’re struggling with flare-ups, treatment or any other aspect of the condition, the first person to talk to is your GP. Let them know what’s happening, how you’re feeling and whether anything’s changed or become worse. They should be able to give you advice, change your treatment or refer you to a specialist clinic.

If you feel unclear about your LS treatment, we’ve created a LS treatment plan template. You could take this along with you to an appointment and ask your doctor to complete it with you.

Will I be referred to a specialist for a diagnosis?

Many GPs, practice nurses and sexual health practitioners have the knowledge and experience to diagnose and look after LS themselves. But in some cases they might feel it’s best to refer you to a specialist (often a dermatologist or gynaecologist).

This might be because they’re unsure about making a firm diagnosis of LS, or for other reasons, for example your skin not responding well to treatment.

Specialists often have long waiting lists, but while you’re waiting for your appointment, you can start or continue with your treatment.

Try to take photos of your vulva before and after starting treatment, so you’ve got a record of how your skin has changed. This is important because if your skin responds really well, there might be no active signs or symptoms of LS by the time you see the specialist, which could make it difficult to be sure of the diagnosis.

The doctor can use the ‘before’ photos to help them make a diagnosis and give you more accurate advice about your treatment going forward.

There are ways of storing photos privately and securely on your phone but if you don’t want to take photos, you or the doctor referring you can take information down on a detailed diagram.

Will I need a biopsy?

It’s not always easy to diagnose LS, so sometimes doctors ask for a biopsy to make sure. This isn’t the case for everyone, but there’s a chance it could happen to you.

Find out more about biopsies, when and why they’re done, and what to expect.

What happens after I see a specialist?

When you’re discharged by your specialist, you’ll be taken off their clinic list and looked after by your GP instead. So if you need to see your specialist again, you’ll need a new referral from your GP.

This approach is recommended under the latest guidelines, because it’s not possible for everyone with LS to stay under a specialist’s care on the NHS. It’s thought that once you’ve got an accurate diagnosis and a treatment plan that works for you, you can be looked after by your own GP, without regular specialist appointments.

If you’ve been discharged, make sure to read our information on check-up appointments and monthly vulva checks at home.

Physiotherapists

If you have problems with incontinence (leaking pee or poo), you might find that irritates your vulva, making your LS symptoms worse.

Physiotherapists who specialise in pelvic health can assess how well the muscles in your pelvic floor are working and recommend treatment, including muscle-strengthening exercises. In many cases, that can help improve bladder and bowel control, in turn easing LS symptoms.

If you’re experiencing pain during sex, a pelvic health physiotherapist can also examine you to check whether your pelvic floor muscles are overly tight. This often happens with LS as your body’s way of protecting itself, but your physio can give you treatment and exercises to help.

Access to local pelvic health physios varies depending on where you live, but you’ll usually be referred by your GP or  gynaecology or dermatology consultant.

Psychosexual counsellors

Research shows that psychosexual counselling (sometimes called sex therapy), can significantly improve the sex lives, happiness and overall quality of life of people with vulval LS. It uses several different psychological and physical approaches to help you explore and cope with the physical or relationship issues you’re experiencing. You can see your therapist on your own or, if you prefer, with your partner.

In some parts of the UK, you can access psychosexual therapy on the NHS, usually with a referral from your GP or consultant.

If psychosexual therapy isn’t available in your area, or there’s a long waiting list, you could also consider a private therapist. The College of Sex and Relationship Therapists (opens in new tab) keeps a list of registered, qualified and accredited therapists who can work with you face to face or online. It’s a good idea to contact a few therapists initially, so you can check how much they charge and find someone you feel comfortable with.

What is a vulval biopsy?

A vulval biopsy involves taking a small sample of skin from your vulva, after numbing the area with a local anaesthetic. You’ll be awake while this happens, and the whole appointment usually only takes 20 to 30 minutes.

The sample is sent to a laboratory, where it’s examined under a microscope to check for signs of LS or other conditions. The results are sent to your doctor. Your doctor should let you know how long this is likely to take. This can vary a lot, because of pressure on services, but it can be several weeks.

What to expect

• Your doctor or nurse will explain what your biopsy involves – either at your previous appointment, or when you arrive on the day. They’ll also ask you to sign a consent form before they begin.
• The appointment usually takes 20-30 minutes and the procedure might take place in a clinic room or a minor surgery room – you can ask in advance where it’s going to be.
• You’ll be asked to undress below the waist and lie on the examination couch.
• As well as the doctor or nurse who’s taking your biopsy, there will usually be another nurse with you, who’ll talk to you and reassure you while it’s happening. If you’d like, they can hold your hand.
• Vulval biopsies are usually done under local anaesthetic, so you’ll have a small injection to numb the skin, and you’ll stay awake the whole time. The needle will feel sharp and local anaesthetic can sting when it’s first injected, but after that, the area will go completely numb and although you might feel some pressure, you shouldn’t feel any pain. You can ask your doctor or nurse to check that the area is numb before they begin.
• Numbing cream isn’t usually used because it can affect how the skin cells appear under the microscope, making it more difficult to diagnose some conditions.
• A small instrument called a punch biopsy is used to take a small sample of skin (usually less than half a centimetre in size).
• After your biopsy, you might have one or two stitches, which are usually dissolvable so they won’t need to be removed. They take 7-10 days to dissolve. If you have stitches that do need to be removed, the doctor or nurse will let you know when and how to arrange this.
• You may have some mild discomfort for a few days after your biopsy.
• It’s a good idea to bring a pad or period underwear to the appointment, as you might have some light bleeding afterwards (usually only a small amount of spotting).

What should I do after the biopsy?

• The local anaesthetic will wear off after an hour or two and you may find the area feels uncomfortable. If you like, you can take over-the-counter pain relief, and if you need any advice, your local pharmacist can help.
• You might find that loose clothes are more comfortable for a couple of days.
• When you go to the toilet, you can just wipe the skin gently with paper as normal. After a poo, make sure you wipe away from your vulva, to keep the biopsy area as clean as possible.
• It’s ok to gently wash your vulva the day after the procedure, using plain water and patting the area gently dry with a soft cloth. Avoid soaking in the bath for the first 2 or 3 days. Your doctor or nurse should let you know when to restart your topical corticosteroids. This will usually be 3 to 7 days after your biopsy.
• Avoid vigorous exercise like running or cycling for a few days after your biopsy because your vulva is likely to be uncomfortable and the biopsy area will be fragile.
• You can start swimming again after your stitches have dissolved or been removed, or once the biopsy area has healed fully.
• It’s ok to have sex a few days after your biopsy, as long as the area is fully comfortable.