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Reassessing the age distribution of vulvar lichen sclerosus: A retrospective cohort study
Evgeny Kreichman1, Oshrat Raviv2, Amy Solnica3
1Department of Obstetrics and Gynecology, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Objective:
Vulvar lichen sclerosus (vLS) is widely reported to affect postmenopausal women and premenarchal girls; however, literature is limited and largely based on histopathologic diagnosis, despite the fact that diagnosis is primarily clinical. We hypothesize that the age distribution of women diagnosed with vLS in a real-world clinical setting, where diagnosis is primarily clinical, is not bimodal and includes a substantial proportion of reproductive-age women.
Methods:
Retrospective cohort study of all women diagnosed with vLS at a vulvovaginal referral clinic between January 2014 and December 2024. The primary outcome was the age distribution of vLS. Secondary outcomes included comorbidities, symptoms, clinical features, and treatment response.
Results:
Among 4,480 women evaluated, 319 (7.1 %) were diagnosed with vLS. Mean age at diagnosis was 45 (±18.3) years. Age distribution did not significantly differ from a uniform distribution (p = 0.99). Classic anatomical features were present in 92 % and 87 % women were symptomatic, with pruritus (76.5 %) and dyspareunia (39.4 %) predominating. Among 214 women diagnosed at first visit, 171 (80 %) returned for follow-up; 94 % reported clinical improvement, with 74.5 % achieving ≥ 80 % symptom reduction, primarily following corticosteroids.
Conclusion:
The age distribution of vLS cases was approximately uniform across adulthood. Clinicians should maintain diagnostic vigilance in reproductive-aged women.