Who Should Manage Vulvar Disorders? A National Survey of Gynecology and Dermatology Residents [16H

Abstract

INTRODUCTION: Vulvar disorders are unique, and it is unclear which specialty is responsible for screening the vulva. We sought to survey behaviors, knowledge and comfort of residents in obstetrics/gynecology (OB/Gyn) and dermatology regarding vulvar disease and evaluate differences among programs. METHODS: This was a cross-sectional, web-based, national survey of OB/Gyn and dermatology residents. Program coordinator email addresses were obtained from FREIDA Online®. Two separate emails requested coordinators forward the author-designed survey to current residents. RESULTS: Two hundred five surveys were completed: 67% OB/Gyn and 33% dermatology. The majority of both OB/Gyn (84%) and dermatology (77%) residents believed OB/Gyns are responsible for screening the vulva. Most OB/Gyn and dermatology residents reported thoroughly inspecting the vulvar area for lesions (62%), though 19% of dermatology residents reported never examining the vulva. Concerning comfort with managing vulvar lesions, only 2% of the total sample felt “very comfortable”. Regarding training, 53% overall reported this as “adequate”, whereas 4% believed they had “very good” training. One-fifth of OB/Gyn residents were “dissatisfied” with their vulvar disorders training. Most residents correctly identified images of vulvar melanoma (80%), squamous cell carcinoma (68%), and lichen sclerosus (98%). Ob/Gyn residents were more likely to correctly respond to items regarding vulvar melanomas (p=.032), biopsy performance (p < .001), and lichen sclerosus diagnosis (p < .001). CONCLUSION: Both cohorts believed OB/Gyns were the appropriate group to screen the vulva. Nevertheless, dermatologists should be able to and offer to perform this exam if not completed recently. A standardized curriculum regarding vulvar disorders could improve training in both specialties.