Summary
Vulval dermatology conditions can be painful, laboursome and life-impacting for patients. Many suffer in silence and have never been asked if their skin condition involves the genitals. The Belfast Health & Social Care Trust initiated a new, nurse-led clinic offering women a dedicated space and time to assess, treat and review their vulval dermatology conditions and the associated psychological impact of living with such conditions.
Method
Evidence suggests that well-controlled vulva conditions have a reduced risk of scarring and malignancy, with symptoms reduced by 98% with increased patient compliance. Applying the ‘BSSVD Standards of Care for patients with Vulval Conditions’, it is vitally important to include specialist nurses in a genital dermatology service, with a focus on patient education, reassurance, counselling and surveillance. Registered Nurse Patricia Cowan identified the need for a dedicated dermatology nurse-led vulval service in Northern Ireland (NI). Patricia pioneered this first-of-its-kind service, advocating for women with debilitating genital dermatology conditions. As an experienced nurse prescriber, she could see not only the physical impact of genital dermatology conditions, but also the psychological impact. To meet the needs of these patients, Patricia enrolled in a cognitive behavioural therapy postgraduate programme. She completed advanced communication skills training, psychosexual counselling courses and educational programmes raising awareness of female genital mutilation in NI.
Results
Audits and patient feedback questionnaires were used in the nurse-led clinic to measure success and shape future developments. Patients were asked ‘Has the use of the 3D visual model improved your understanding of your vulval condition?’ and ‘How satisfied are you with the nurse-led vulval service?’ Feedback demonstrated 100% patient satisfaction and highlighted the physical, psychological, sexual and quality-of-life implications for patients living with genital dermatology conditions. A 75% reduction in patient waiting lists was seen within three months through the introduction of a weekly, nurse-led clinic. This increased capacity for new patients to access the service. Patricia has delivered education sessions to physiotherapists, GPs and nurses across NI to highlight the need to assess, and appropriately refer, patients with genital dermatology conditions.
Sustainability and Spread
Patricia’s work at the clinic has been published in many nursing and dermatology journals. She has also co-authored the first national nursing competencies in relation to genital dermatology nursing, which has created a pathway for nursing to support this patient cohort now and in the years to come.
