Lichen sclerosus, genital trauma and child sexual abuse

To describe the clinical features of lichen sclerosus affecting the genitalia of three unrelated prepubertal girls in whom concerns of sexual abuse had been raised.

three girls ranging from 4 to 9 years of age presented with similar genital and anal findings. Their labial skin was atrophic with pale opalescent patches and a variable amount of labial bruising, haemorrhagic blistering and bleeding. In two, the perianal skin was involved in a similar fashion. In each case the hymen was normal with no sign of acute or chronic trauma.

Lichen sclerosus affecting the genitalia of prepubertal females is an uncommon condition that may be mistaken for trauma associated with sexual abuse. An awareness of its clinical features is essential not only for those doctors who examine children for physical signs of sexual abuse but also for primary care doctors who may be confronted with an apparently abused child. Early recognition of this disease should, in the absence of other concerns, prevent unnecessary intervention by police and child protection workers.