Medical Advice

Medical Exams

What will happen when you see a doctor about a vulval problem?

There is probably nothing more embarrassing than going to a doctor with a problem “down there”, particularly if in addition to feeling sore or itchy, you are also having problems with being able to have sex or unable to enjoy sex.

Many people put this off for a long time before they approach a doctor, sometimes for years. This is particularly true for women middle aged and beyond, but it happens at all ages.

If you are feeling really uncomfortable about this, it might be best to see a female doctor. This isn’t any reflection on male doctors. They will be fine with it. But will you?

If you don’t feel you can approach a doctor you have been seeing for years because it just seems too embarrassing, by all means choose another doctor, but think carefully about that. Again, your own doctor would probably not be embarrassed and he or she might feel hurt that you thought you couldn’t talk about it . If your doctor has known you a long time that’s a good thing and he or she might surprise you.

If you don’t have a regular doctor and don’t know where to turn, a good starting point might be someone from an organization such as Family Planning. These doctors specialize in all aspects of women’s health.

When you see the doctor, he or she will ask you to tell them the story of what happened right back from the beginning. Try to get your thoughts organized before you go in or write yourself a note. People with vulval problems are often very upset and pour out huge amounts of information. Doctors can easily get confused if you are rushing through everything that happened, so try to start at the beginning and work through to the end one thing at a time.

It can really help to know the medical terms that refer to your vulva. That way you can accurately tell your doctor where the problem is and when he or she is talking to you about it, you’ll understand better what is being said.

Don’t forget to mention all the medications you take. The doctor will ask you about things that have been prescribed, but also mention over the counter things like panadol, nasal decongestants, vitamins particularly glucosamine. If you are taking recreational drugs, mention them as well. Believe it or not, some drugs can cause vulval problems and if a doctor is going to prescribe something for you, he or she needs to know everything you are taking in case there are any incompatibilities.

Also mention all the things that might have made contact with the skin of your vulva in case you could be allergic to something. Think about this as well before you go in. Remembering all those things can be really difficult on the spot.

After the doctor has talked to you, he or she will examine you. People worry a lot about genital examinations, particularly the thought of having your legs put up in stirrups or on foot rests. They also worry about internal examinations, particularly that these are going to be uncomfortable.

It depends a little on the type of doctor you see as to what sort of position you will be asked to lie in. Gynaecologists often have a foot rest at the end of the bed but general practitioners and dermatologists usually just examine you lying on your back. You’ll be asked to let your legs flop apart. This can feel very confronting and some patients just can’t bring themselves to do it or feel that they have to keep a hand over their vulva if they do. If you feel as frightened as this consider bringing a support person with you.

The doctor is going to have a look at your vulva and the skin around the back passage. The rest of your skin, including inside your mouth might then be examined to determine if your vulval problem is part of something that involves other parts of your skin.

When it comes to most vulval problems, an internal examination is not required, however if your vagina is inflamed or you have a discharge, your doctor will need to put in a vaginal speculum (these are clear plastic instruments that are inserted and used to open up the wall of your vagina so the doctor can see inside). It may be a bit uncomfortable but it usually only takes a minute or two to have a look.

In terms of tests there are two that are often needed if you have a vulval problem.

The first is a VAGINAL SWAB. This is done simply by inserting a long cotton bud into your vagina. It only needs to be inserted a couple of centimetres. If you have blisters, another swab will be taken from a blister.

The second test is called a VULVAL BIOPSY which means cutting out a very small sample of skin about 3mm in diameter. It doesn’t need to be done in every case but it can be very helpful for certain conditions and will always be done if there is any suspicion of cancer. The doctor will inject a small amount of local anaesthetic after applying a numbing cream first. You may feel a brief sting when the local is injected. The biopsy itself takes about a minute or less to do. No stitches are usually needed and you can go straight home afterwards. When the local anaesthetic wears off the biopsy may be a bit sore, so you may need some panadol. However it usually heals very quickly. Don’t attempt to have sex for a week after a vulval biopsy.

When all this over, hopefully your doctor will have a diagnosis and suggest treatment. If your doctor is not sure what is going on however, it’s likely you will be referred to a specialist, most likely a gynaecologist or a dermatologist depending on what sort of problem you have. This means you may have to go through the whole process again.

Remember, vulval problems aren’t as well understood as we would like. So if your doctor wants to refer you to an expert, that’s a good thing!