When should I consider referring a patient with vulval conditions to a specialist for further evaluation?

Consider referring a patient with vulval conditions to a specialist for further evaluation if they present with:

• Unexplained vulval bleeding.
• Unexplained vulval lump or ulceration.
• Any vulval symptoms suspicious for cancer, such as persistent lumps or ulcers.

These features warrant a suspected cancer pathway referral to ensure timely specialist assessment and management.

Additionally, refer women with suspected mesh-related complications involving the vulva to a urogynaecologist, urologist, or colorectal surgeon for specialist assessment. This includes symptoms such as pain, palpable or exposed mesh, or unexplained symptoms after mesh procedures.

For vulval conditions not clearly suspicious for cancer or mesh complications, consider referral if symptoms are persistent, unexplained, or significantly impact quality of life, or if initial management in primary care is unsuccessful.

Always take a detailed history and perform a thorough examination to guide the decision to refer.

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