The purpose of this study was to investigate challenges women face before inflammatory vulvar dermatosis diagnosis to guide interventions for improving time to diagnosis and health care experiences. Materials and Methods:The present analysis was part of a larger study exploring sexual health and quality of life of women with vulvar and nonvulvar inflammatory dermatoses, evaluated via a 20-minute web-based survey. One open-response item asked participants to "briefly describe any challenges you faced with regards to health care or health care providers in the time when you were seeking a diagnosis"; this item informed the present study. Eligible participants were women older than 18 years, living in the United States, with diagnosis of an inflammatory vulvar dermatosis persisting at least 1 month. Participants (n = 118) had a mean age of 46.55 ± 15.35 years, and 64% (n = 75) had lichen sclerosus.Results: Provider-based challenges consisted of insensitive communication and ascribing physical symptoms to mental health issues, self-harm, or other factors. System-based challenges included confusing referral networks, limited specialist access, and widespread lack of provider education. Personal challenges for participants seeking care included feelings of embarrassment and reduced health care efficacy. Challenges led to emotional response and impact for participants, characterized by negative (e.g., distrust in the medical system) or positive (e.g., self-advocacy efforts, strong social media communities) outcomes. Conclusions:Findings provide unique insights into the challenges women experience before inflammatory vulvar dermatosis diagnosis. This study creates new knowledge exploring the diagnostic journey accompanying inflammatory vulvar dermatoses and contributes practically to clinical and research needs of this understudied population.

Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September–November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19–81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly ( p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed. Supplementary Information The online version contains supplementary material available at 10.1007/s10508-022-02353-0.

This research explores the unintended consequences of recent development trends for small businesses along Yonge Street between Bloor Street and College/Carlton Street in Toronto. By examining development projects between 2007 and 2018, the preference for large retail units at ground level with high-rise residential condominium towers above is evident. Heritage buildings and attributes are being demolished, where allowed, to create the base that supports this type of development. New development projects are increasing property values and taxes, and commercial rents. The lack of appropriately sized and priced retail space is displacing successful small businesses. The residents who are new to the neighbourhood are increasingly young persons who have higher incomes and levels of educational attainment. Small businesses may be unable to adapt to their consumer preferences. Key opportunities are identified for the City of Toronto to support successful small businesses in the neighbourhood and to maintain the character and heritage of Downtown Yonge Street. Key words: planning; commercial gentrification; displacement; small businesses; Toronto

This research explores the unintended consequences of recent development trends for small businesses along Yonge Street between Bloor Street and College/Carlton Street in Toronto. By examining development projects between 2007 and 2018, the preference for large retail units at ground level with high-rise residential condominium towers above is evident. Heritage buildings and attributes are being demolished, where allowed, to create the base that supports this type of development. New development projects are increasing property values and taxes, and commercial rents. The lack of appropriately sized and priced retail space is displacing successful small businesses. The residents who are new to the neighbourhood are increasingly young persons who have higher incomes and levels of educational attainment. Small businesses may be unable to adapt to their consumer preferences. Key opportunities are identified for the City of Toronto to support successful small businesses in the neighbourhood and to maintain the character and heritage of Downtown Yonge Street. Key words: planning; commercial gentrification; displacement; small businesses; Toronto

No abstract