Presenting Symptoms and Diagnosis of Vulvar Lichen Sclerosus in Premenopausal Women: A Cross-Sectional Study

Abstract

Objectives/PurposePresenting symptoms of vulvar lichen sclerosus (LS) specific to premenopausal women are not well reported in the literature and may differ from those in postmenopausal women. This study aimed to characterize the presentation of vulvar LS among premenopausal women.Materials and MethodsAn observational web-based study was conducted in premenopausal women with biopsy-confirmed vulvar LS between the ages of 18–50 years. Participants completed a 28-question survey evaluating characteristics of symptoms, timing of diagnosis, alternate diagnoses, and presence of concomitant autoimmune conditions.ResultsOf the 956 responses received, 503 met inclusion criteria of biopsy-confirmed LS and premenopausal status. Average age of symptom onset was 27 years, and average age of diagnosis was 32 years, with a 4-year delay in diagnosis. Symptoms most present were dyspareunia (68%) and tearing with intercourse or vaginal insertion (63%). Symptoms that affect the individual most were also dyspareunia (44%) and tearing with intercourse or vaginal insertion (39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%) and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulvar fissures (72%), and labial resorption (60%), with fissures affecting the individual the most (48%). Sixty-six percent of the respondents initially received an alternative diagnosis, most commonly vulvovaginal yeast infection (49%). Hypothyroidism was the most common concurrent autoimmune condition (10%).ConclusionsVulvar LS affects premenopausal women, commonly presenting with dyspareunia and tearing with intercourse. This condition should be considered and evaluated in premenopausal women presenting with vulvar symptoms and sexual pain.

A retrospective comparative cohort study of ultra-pulse CO2 lattice laser and glucocorticoids in the treatment of vulvar epithelial nonneoplastic lesions

“…He et al tested 8 kinds of autoantibodies in 142 patients with lichen sclerosus and found that 48% of the patients were positive for autoantibodies (25). Krapf et al recorded the clinical manifestations and long-term follow-up of 40 cases with Vulvar lichen Sclerosus (26), their results also showed that the HLADQB10201 allele was present in 80% of patients and 41.8% of controls (RR: 3.71; P≤0.0042). Altogether, various pathological types show different therapeutic responses, and the reasons for this need to be further investigated.…”

Lichen sclerosus: The 2023 update

“…However, VLS can affect women of any age and the proportion in fertile women could be higher than expected. In a survey of women of reproductive age with histological confirmation of VLS, the mean age of diagnosis was 32 years, with symptom onset at 27 years ( 14 ). Furthermore, up to 40% of the surveyees described symptoms prior to menopause or they were diagnosed with asymptomatic VLS during the gynecologic examination ( 11 , 15 ).…”

Pregnancy, parturition and postpartum considerations among patients with vulvar lichen sclerosus: A retrospective cross‐sectional online survey

“…Lichen sclerosus (LS) is a chronic, inflammatory skin condition affecting the anogenital epithelium in women of all ages, including premenopausal women. 1,2 The true prevalence of VLS is unknown, with estimates ranging from 1.7% in one US general gynaecology practice to 3% in an elderly Israeli population. 3,4 The prevalence of VLS in reproductiveage women is unknown.…”

“…12 On the other hand, reproductive-age women with VLS may be affected more by sexual symptoms than by pruritus. 2,11 A study of reproductive-age women with 'early onset' LS indicates that the use of anti-androgenic oral contraceptive pills was associated with symptoms and diagnosis of VLS. 13 Hormonal changes during pregnancy include increases in both estrogen and androgen levels, which may influence VLS symptom profile and severity during pregnancy and postpartum.…”

“…Hypoestrogenic states are also an independent risk factor for vulvar pruritus in the general population 12 . On the other hand, reproductive‐age women with VLS may be affected more by sexual symptoms than by pruritus 2,11 . A study of reproductive‐age women with ‘early onset’ LS indicates that the use of anti‐androgenic oral contraceptive pills was associated with symptoms and diagnosis of VLS 13 .…”