Introduction/Background Rates of vulval cancer are increasing globally. Early detection reduces surgical morbidity and prolongs survival. Although population screening has no role, vulval self-examination may prompt early diagnosis in women at increased risk of vulval cancer. UK guidance promotes self-examination in women with high-risk conditions, but there is a lack of evidence about current practice, acceptability and barriers to self-examination.
Methodology Clinician questionnaires were completed at a British vulval conference. Patient questionnaires were distributed through online patient networks and clinics. Patient and clinician focus groups recruited through purposive sampling analysed thematically explored barriers and facilitators of self-examination(n=28).
Results All ninety-eight clinicians agreed that self-examination plays an important role in detecting sinister vulval changes in high-risk women. 87% recommended monthly self-examination and 81% provided one-to-one teaching.
455 patients(median age 58 years) with lichen sclerosus(69%), lichen planus(13%), vulval cancer(14%) and VIN(13%) participated. Clinic respondents(n=197) were older(median 65 years vs 52 years, p<0.001) and 65% reported self-examining compared with 86% of online respondents(p<0.001). Despite regular self-examination, 40% were not confident about recognising vulval abnormalities. Face-to-face specialist teaching was regarded as the best way to learn self-examination; only 9% reporting receiving this.
Themes from focus groups were developed based on experience of vulval self-examination: facilitators (patients’ confidence and familiarity with their bodies, individualised teaching by clinicians, contributing to empowerment of self-management and allowing early detection of sinister changes), barriers: (poor health-care experiences, lack of awareness amongst patients, lack of confidence in self-examination and identifying abnormalities, embarrassment, distress at changing vulval anatomy, physical barriers to visualising the vulva).
Conclusion Patients and specialist vulval clinicians recognise that vulval self-examination is important in early detection of vulval cancer, but a lack of formal teaching impairs confidence in the identification of abnormalities. Healthcare professional-led education and support may facilitate patients to self-examine and manage their long-term vulval conditions.
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