Female Genital Dermatology

Northern Sydney Dermatology & Laser offers a Female Genital Clinic run by Dr Liz Dawes-Higgs.

This is a very specialised clinic, where the upmost care is taken in making you feel calm and relaxed. Dr Dawes-Higgs is known for being able to put her patients very quickly at ease. This clinic addresses all aspects of the skin of the female genitalia, known as the vulval area. Some conditions which are diagnosed includes chronic vulvovaginal candidiasis, lichen sclerosis and lichen planus. Many common skin conditions can also affect the vulval area, including dermatitis and psoriasis.

What are the symptoms of vulval disease?

Many women with vulval disease can suffer years with undiagnosed symptoms. They often endure constant itching, scratching, and even pain, leading to a withdrawal from life, work, and relationships. Symptoms that can occur in this area include an itch, irritation, pain, burning and stinging. Sometimes it can even be just an awareness. Dyspareunia (pain with sexual intercourse) can occur as well.

Some symptoms can come and go and some are present constantly. Previous treatments can help but some of these can make symptoms worse.

There are many triggers that can worsen symptoms. These include hair removal practices, tight clothing, pads, and liners along with personal hygiene practices. Some soaps and body washes can be very harsh on the skin, along with other perfumed products such as moisturisers and hygiene sprays. More recently, allergens in cleansing wipes have been found to cause allergies.

How should I prepare for my first appointment?

Once you have made an appointment to attend the Female Genital Clinic, you will be sent an information pack. This will welcome you to the clinic and asks that you complete a questionnaire that helps with your visit. This allows Dr Dawes-Higgs to better understand you and your symptoms, providing you with the best possible care. On this information sheet are instructions on what to do before your appointment, including when to stop your current treatments.

Dr Dawes-Higgs is a Fellow of the Australasian College of Dermatologists and was awarded her Fellowship in 2006. She specialises in women’s skin health and is a lecturer in vulval dermatology at the FPAA National Certificate in Reproductive and Sexual Health for doctors. She is also a State and National examiner for the Australasian College of Dermatologists and will soon take up the college position of NSW formulating exams and conducting the Fellowship examinations for new Dermatologists entering the field.

What to expect at your first appointment

On arrival at Northern Sydney Dermatology & Laser, you will be met by our friendly reception staff. A nurse will then take you in to see Dr Dawes-Higgs. Together you will go through the questionnaire about your symptoms, and general medical history that you will have filled out before arriving at the clinic.

You will be examined in a private examination room that is custom-designed for privacy and to ensure that you will feel at ease. Depending on your examination, a biopsy may be required to ascertain the exact cause of your symptoms. A biopsy will be discussed beforehand and you most likely will return to have this performed. This is usually relatively pain-free, as a local anaesthetic is used and after this, you really will not feel the biopsy procedure. A small piece of skin is taken and is sent to the laboratory for further analysis. This can take about a week.  Usually no sutures are required and you may notice a little bit of spotting of blood after the procedure. A nurse will be present to assist during this time and will explain all of the aftercare instructions.

Sometimes a swab is required. This can be of the hair-bearing skin, over an ulcer if you have one or alternatively, be a low vaginal swab. Again, this is a painless procedure and the results are usually available in about a weeks’ time. Finally, Dr Dawes-Higgs may ask you to have some bloods performed. This procedure is taken at a local blood taking collection centre and is done at your own convenience. This is not always requested and depends on your symptoms and condition.

General care of the vulval area

General care of the vulval area is very similar to other body areas. The difference is that it is very difficult to monitor this area. To do so, Dr Dawes-Higgs advises the use of a mirror to examine your vulval area. The mirror can be placed for example on the top of a closed toilet seat with one leg resting on the seat to help.

Contrary to belief, perfume sprays and deodorants are not required in this area. In fact, these can be quite irritating. A gentle soap and a gentle moisturiser depending on your condition is all that is required for the general care of this area.

If you have a vulval dermatosis which has been diagnosed by Dr Dawes-Higgs, she will discuss  further treatments with you such as anti-inflammatory creams. The female genital area can be easily irritated with practices such as hair removal, bubble baths, and certain sporting activities including cycling. Some people can have allergies to certain products and certain treatments. This leads to a confusing state where application of the treatment cream can initially help but then lead to a worsening of the condition. If this is suspected then often an allergist will be consulted to determine the exact allergy.

Treatment of vulval dermatosis

Treatment of vulval dermatosis usually includes the application of topical anti-inflammatory creams.  Some of these may need to be applied lifelong. They vary in strength and will be tailored to your specific condition. Rarely tablets are required to treat a vulval condition and these can include antifungal medications along with immunosuppressant therapy for conditions such as lichen planus.

General skin care measures are equally as important and these include gentle soap-free wash, moisturisers, and lubricants if required.