The female external genitalia have long been considered a taboo subject. Even amongst women, there continues to be a general reluctance to speak on the subject, with women often experiencing difficulty in finding language referring to what is “down there”. As a doctor who specialises in women’s health, I perform genital examinations for my patients on a daily basis. Even the suggestion of an intimate examination can cause a great deal of discomfort for many women. I am saddened to admit that the phrases ‘I don’t know how you bear to do this job” and “I’m sorry for how things look down there..” are ones I hear on a daily basis. What often feeds into this discomfort is that many women are unsure about the features of their own genital anatomy. The very word ‘vulva’ is rarely used in public discourse and in a recent study, 60% of women were unable to correctly identify the vulva on an anatomical diagram.
Unfortunately, the vulva may similarly be an area of poorer knowledge and understanding for many healthcare professionals. There remains a concerning lack of medical resources and textbooks with information about normal (healthy) vulval appearance. One study of medical textbooks identified an absence of accurate descriptions of normal female genitalia in the standard textbooks used by medical students and trainee doctors. This may well contribute to lack of confidence when examining women and girls.
I am absolutely delighted that The Eve Appeal is launching ‘An overview of cancer of the vulva’, a much needed resource for all those involved in the care of women and girls. This document provides an important reminder of normal genital anatomy, an introduction to a range of vulval conditions, and an emphasis on the holistic care of those experiencing them. This information is essential for all healthcare professionals involved in looking after and examining women with genital problems and symptoms, from nurses to GPs to sexual health professionals. It is also a vital reminder of the importance of spotting the signs of vulval disease as early as possible, to support our patients, provide prompt treatment and prevent progression.
As I often tell my patients, the trust bestowed in us to perform intimate examinations is an absolute privilege. With this privilege comes the responsibility to maintain our knowledge and competencies, and provide the best possible care to our patients. This guideline is a welcome tool to help us achieve this.
If you’re a healthcare professional, you can download our vulval cancer training resource.