Dr. Amanda Selk: Educating the world about vulvar dermatology

Back when Dr. Amanda Selk was on the cusp of completing her residency with our Department, she was initially unsure which direction to take her subsequent training.

At the time, she had been leaning toward pursuing a fellowship in maternal-fetal medicine, but wasn’t convinced that it would be the exact right fit. Where many newly graduated residents might take some time off to travel and ponder their next move, that also wasn’t an option at the time for Selk, who had a young child at the time and was due to give birth to her second mere weeks after the end of residency.

And then came the very last rotation of Selk’s training: colposcopy. She had no way of knowing it, but in that final rotation, Selk would stumble upon her professional path — and it was largely because she was simply looking for a chance to rest her aching feet.

“I only did that rotation because I was really pregnant and I wanted to sit down, I thought colposcopy was something I should learn more about, but I had no plans to include it in my practice” Selk recalls with a laugh. “It’s funny how things work out.  It turned out that I really enjoyed both colposcopy and vulvar dermatology, and I had an eye for it.

“I decided to seek more training in vulvar dermatology myself. There was no fellowship anywhere in the world at the time, so I sort of built my own training program. I went to Dr. Michael Shier’s vulva clinic at Sunnybrook and got some exposure that way. I spend time with Dr. Alan Gerulath at St. Mike’s. I spent a year working with a dermatologist, Dr. Agnes Reicher, who had run 40 years of vulva clinic and then we had a joint clinic together for five years.”

Now, Selk is fellowship director of our Department’s vulvovaginal health fellowship, a one-year training program for ob-gyns looking to develop their expertise in vulvar dermatology, preinvasive disease, vulvar pain, and the management of graft-vs-host disease.

Selk says the program grew from a pressing need to develop more specialists in the area and begin to close a knowledge gap around vulvovaginal health that persists among both providers and patients alike.

“Both vulvar dermatology and colposcopy are about looking for little patterns and visual things that you don’t necessarily learn in general ob-gyn training. It’s not necessarily hard, but people are uncomfortable in areas they don’t have training in,” says Selk, an associate professor in our Department.

“This seems to be a global issue — similar to menopause — where it’s a common problem that tons of people have issues with but there are not a lot of knowledgeable providers. Personally, my wait list for vulvar patients is 18-to-24 months, and I’m forced to turn down 90 per cent of my referrals right now. I’ve had to close in the past due to capacity issues. It’s really hard.”

“When patients do get care for these issues, they are so grateful. Many of them have been bounced from place to place. So I’ve tried to figure out ways to train other people, because I can only see so many patients myself.”

In addition to the fellowship program she helped to launch, Selk has been proactive in finding ways to educate the public and other physicians about vulvovaginal health issues.

She maintains an active and authoritative social-media presence and serves as the social-media editor for the Journal of Lower Genital Tract Disease, the international journal for colposcopy and vulvovaginal health. She is the Social Media Committee Chair for the International Society for the Study of Vulvovaginal Disease (ISSVD).  Selk is the immediate past-president of the North American chapter of the ISSVD and the Society of Canadian Colposcopists.

Selk is also the host of the medical podcast The Vulva Diaries. She created the podcast somewhat casually as an experiment, merely hoping to catch the ear of a few clinicians who might be too busy to absorb the information through books or conferences.

The podcast’s 39 episodes have now drawn listeners in 120 countries and is in the top 2 per cent of all podcasts in the world based on global reach. ISSVD has adopted the podcast as official educational resource.

“It’s funny because it was this small thing that turned into a worldwide education project,” Selk says.

Ultimately, Selk’s educational efforts are especially important both because many patients struggle to find proper care for vulvovaginal health issues, and because many patients are too embarrassed to raise the problems with their providers in the first place.

“There are two sides to this. There’s a clinician problem in some cases, where a patient may have a problem and some clinicians won’t even examine the patient — they’ll just treat them for a yeast infection. On the patient side, there can be a lot of embarrassment about vulvovaginal health issues. Even getting patients to have exams can be difficult,” Selk says.

“Social media is important because we have to understand that people are searching for information about their medical symptoms all the time, but what’s lacking is health literacy. I can scan something quickly and say whether it is good information, but a lot of people don’t have that ability and there is a lot of misinformation online.”

“So I think the best thing we can do is put out good information and promote it.”

Dr. Emily Delpero was the first graduate of our vulvovaginal health fellowship. Looking back, the program seemed to come along at exactly the right time.

“It was unexpected but kind of a lightbulb moment: this was exactly what I had been looking for to fill those gaps in training that I’ve been sensing,” Delpero recalls. “I look back and feel so lucky that Dr. Selk was my fellowship advisor and mentor. There’s a lot of talk about the difficulties women face in medicine but she is one of those types who holds the door open and was always giving me a hand up, always looking to help me advance my career.

“She’s a very curious person and very ingenious in the way that she’s adapted academic educational material for her patients. Her passion really shines through on a daily basis, which I found very inspiring.”

“Dr. Selk is an excellent teacher,” added Dr. Jaime Reardon, another graduate of our vulvovaginal health fellowship. “As a learner, I always felt supported and like my learning goals were very important. I started learning the very first day of my fellowship with her, and right up until the very last day, I was still learning new things from her every single day.

“She really is an expert — she’s right up there with the best of the best in the world. She’s an inspiring person to learn from.”

Both Selk’s former trainees and colleagues agree that she is not only inspiring because of her achievements in the field, but also the way she balances her daunting workload with a rich personal life.

Selk, now a mother of three, is also a former varsity ice dancer and nationally certified figure skating coach who has in recent years returned to the ice. She also recently somehow found time to complete a full-time executive master of health administration (EMHA) program at the University of Ottawa.

“It’s hard to find work-life balance. Dr. Selk is a world-leading expert in vulvovaginal dermatology. She is a leader. She is a skilled figure skater. She is a highly attentive mother of three. She’s a physician and she’s married to a physician. She took it upon herself to enrol in a master’s program in health leadership not for any specific promotion or goal, but just so she could become a better leader within health administration,” said Dr. Michelle Jacobson, an assistant professor in our Department.

“She manages to do all of that while maintaining an international reputation and clinical practice.”

Added Delpero: “Dr. Selk is like an Energizer bunny — she’s so driven.”

Indeed, even though mere months have passed since Selk acquired that second master’s degree (her first was in health research methodology/clinical epidemiology from McMaster University, completed just after the end of residency), she is already beginning to wonder what’s next.

“I think I’m just a lifelong student — I like to say I just finished year 17 of university,” Selk says with a laugh.

“I’m just someone who thrives on learning new things and I’m always trying to improve my knowledge and skills.

“I will say that since I finished — even though I’m doing a hundred things at once — I’m starting to feel like I have a lot of free time again. As I finish one thing, I tend to replace it with another thing. That is my style and it’s led to lots of amazing experiences.”