Box 1.

Differentiation of selected common vulval disorders^4–6

	Vulval lichen sclerosus	Genitourinary symptoms of menopause	Candidiasis
Itch	Yes, often severe	Yes	Yes
Age	Any but more common pre-puberty and post- menopause	Related to low oestrogen states	More common post- puberty, pre- menopause
Colour	White	Pale pink	Red if inflamed
Vaginal involvement	No	Yes	Yes
Change in architecture	Yes, often severe, may be asymmetrical. Fusion/scarring of clitoral prepuce	Yes, usually mild, symmetrical, gradual. Retraction of clitoral prepuce	No, but may have temporary swelling during flares
Perianal involvement	Yes	No	No
Associated with incontinence	Yes	Yes	No
Discharge	No	Possible	Often