A systematic review of the barriers to diagnosis of vulval lichen sclerosus in primary care

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative synthesis

• Effect Size: Not applicable for qualitative synthesis

• Primary Outcome: Six analytical themes: medically challenging diagnosis, cultural/social taboos, education/knowledge gaps, feelings/attitudes, inadequate health systems, challenges in female genital examination

• Nnt Or Sensitivity: Thematic saturation achieved across 56 studies with consistent barrier identification

• Confidence Interval: Not applicable for qualitative synthesis

Clinical Application

Highly feasible - recommendations for clinician education and improved consultation approaches can be readily implemented Directly applicable to Australian general practice. RACGP guidelines could incorporate educational recommendations. Medicare item numbers for extended consultations may support thorough vulval examinations. Cultural sensitivity particularly relevant in multicultural Australian context Australian women presenting to general practice with vulval symptoms, particularly relevant given similar primary care structures to UK

Abstract

BACKGROUND: Vulval lichen sclerosus (VLS) is a chronic, inflammatory genital skin condition causing itch, pain, anatomical changes and increased risk of vulval cancer. Diagnostic delay and misdiagnosis are common. Once diagnosed, VLS can be effectively treated using very strong topical corticosteroids. Most women with symptoms of VLS first present to primary care in the UK. OBJECTIVES: To identify patient and professional perspectives on barriers to diagnosis of VLS in primary care through systematic review and thematic synthesis of the literature. METHODS: Separate literature searches of seven databases relevant to patient and professional perspectives were conducted. Two reviewers screened titles and abstracts, with one performing a full text review. Data extracted were coded 'line by line', codes were organized into descriptive themes and subsequently developed into analytical themes. RESULTS: We identified 2468 references; a total of 56 studies met inclusion criteria. Six analytical themes were developed: (i) a medically challenging diagnosis; (ii) cultural and social taboos; (iii) education and knowledge gaps; (iv) feelings and attitudes; (v) inadequate health systems; and (vi) challenges in female genital examination. CONCLUSIONS: This review highlights obstacles for women in achieving a diagnosis of VLS. Education and knowledge gaps were reported by clinicians and patients. Clinicians lack knowledge of vulval skin disease and patients lack knowledge of vulval anatomy. Targeted, comprehensive education for clinicians could expedite diagnosis. Dismissive clinician attitudes compound patient feelings of anxiety and embarrassment, reinforcing taboos and stigma. Acknowledgement of embarrassment and stigma validates feelings, improving patient interactions. Future research priorities should include the development of a diagnostic tool and implementation of a complex intervention to expedite diagnosis.

References

1. 1.Clarke, L., Leatherland, R., & Simpson, R. C. (2026). A systematic review of the barriers to diagnosis of vulval lichen sclerosus in primary care. Clinical and Experimental Dermatology. https://doi.org/10.1093/ced/llaf481