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Vulval complaints are common, with 45% of general practitioners seeing more than one patient a month with recurrent symptoms [9]. Patients with vulval problems present to a variety of health professionals, including gynaecologists, dermatologists, genitourinary physicians, urologists, physiotherapists, and paediatricians. This can often lead to confusion and inappropriate management, with varying approaches according to specialty. Specific clinics dedicated to vulval and vaginal disorders provide the most appropriate setting for any patient with these symptoms to be seen. They should be run by trained medical and nursing staff, with the equipment necessary for diagnostic investigation readily available. This combined approach is a valuable resource, beneficial in management, teaching, and research.

The first vulval clinic was held at Tulane University School of Medicine, Louisiana, in 1957 [10]. The number of vulval clinics available has increased dramatically, and the benefits of such clinics have been shown [11–13]. There are published standards of care of vulval clinics in the United Kingdom [14], but audits show that there is still some way to go with full compliance [15].

There are many vulval conditions which require the input of different specialists, and multidisciplinary working is the best way of approaching this. The way that individual clinics are run can vary but should be led by adequately trained sub‐specialists who continue to develop their skills in the field. It can be helpful to hold combined clinics with other specialists present to see the patient at the same time, but it is most important to build links with other specialties who may be needed at different times to manage specific issues related to the patient’s vulval condition. A good example is that of erosive lichen planus, where complications at distant sites such as the lacrimal duct and external auditory meatus would need referral to ophthalmology and otorhinolaryngology consultants, respectively. A wide range of other specialties may need to be involved in some aspect of patient care (Figure 5.1), but this should be coordinated through the vulval clinic.

Figure 5.1 The multidisciplinary specialities that are required for patients with vulval disease.

Another vital facet of multidisciplinary working relates to clinicopathological correlation, and working closely with the pathologist is essential. It is important that the clinical and histological diagnosis concur, and if there is doubt, biopsies may need to be repeated. Agreement and understanding of changing classifications and terminology must also occur between clinicians and pathologists to avoid confusion. It has been shown that cooperation between gynaecology and dermatology pathologists improves the accuracy of reporting of vulval biopsies [16].