Vaginal and vulval conditions

Non-hormonal preparations for vaginal atrophy:
In certain situations a vaginal moisturiser such as Hyalofemme®, Sylk® or Replens MD® may be helpful.

Vulval lichen sclerosis:
Topical clobetasol propionate (Dermovate®) (Topical corticosteroids) should be used as first-line in women with vulval skin changes in keeping with lichen sclerosus.  Apply once nightly for 4 weeks for flares, reducing to alternate nights for 4 weeks and then continuing twice-weekly use as maintenance indefinitely.  Most women will have a swift improvement in symptoms; referral for biopsy is not necessary if there is a good response to treatment. No more than 30 grams should be used every 3 to 6 months.  Recommend washing the area with Zerobase® cream (Emollient and barrier preparations).  Refer to British Association of Dermatology guidance and patient information leaflets.

Please consider if a steroid emergency card needs to be given to the patient alongside the traditional steroid treatment card.  This is to support the timely recognition and treatment of potential adrenal crisis and is suitable for some patients on oral, inhaled, topical or rectal steroids.  For more information, including which patients should receive the card, see HIS for details.  Steroid emergency cards have been distributed to, hospitals, GP surgeries and community pharmacies. Primary care can order replacement cards from 01463 706886.
See Peri-operative guidelines for patients with or at risk of adrenal insufficiency

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