A Longitudinal Multiinstitutional Study of Vulvar Lichen Sclerosus: From Childhood to Perimenopause

Di Giuseppe J, Jacopo Di Giuseppe, Delli Carpini G, Giovanni Delli Carpini, Giannella L, Luca Giannella, Terenzi T, Tomas Terenzi, Fichera M, Mariasole Fichera, Federica Ragno, Ragno F, Campanati A, Anna Campanati, Veronica Boero, Boero V, Caia C, Carlotta Caia, Elisa Pesce, Pesce E, Paolo Vercellini, Barbara Gardella, Gardella B, Mattia Dominoni, Dominoni M, Arsenio Spinillo, Spinillo A, Francesco Sopracordevole, Sopracordevole F, Clemente N, Nicolò Clemente, Del Fabro A, Anna Del Fabro, Riccardo Rossi, Rossi R, Monica Corazza, Corazza M, Alessandro Borghi, Ruby Martinello, Martinello R, Greco P, Pantaleo Greco, Giuseppe Rizzo, Rizzo G, Anna Angela Criscuolo, Criscuolo AA, Mappa I, Ilenia Mappa, Matteini E, Enrico Matteini, Botti E, Elisabetta Botti, Elena Campione, Campione E, Luca Bianchi, Bianchi L, Ciavattini A, Andrea Ciavattini
Journal of lower genital tract disease · 2024 · vol. 28(3) , pp. 276–281 · doi:10.1097/LGT.0000000000000816 · PMID:38661348
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-09 ⓘ

This study evaluated clinical characteristics, comorbidities, and treatments in vulvar lichen sclerosus patients from childhood to perimenopause, finding significant differences in symptoms and affected areas between premenarchal and postmenarchal groups.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-09-17 · read from full text ⓘ

This longitudinal multiinstitutional study evaluated clinical characteristics and comorbidities in 186 patients with vulvar lichen sclerosus ranging from childhood to perimenopause. The researchers compared premenarchal and postmenarchal groups, finding that younger patients presented with significantly more severe signs such as bleeding, fissures, and perianal involvement. Additionally, treatment approaches differed between the two age groups, with topical calcineurin inhibitors being more common in premenarchal patients. The authors note that misdiagnosis often delays treatment, highlighting the need for age-specific recognition of symptoms. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

OBJECTIVE: The main outcome of this study was the evaluation of clinical characteristics, comorbidities, and therapeutic approaches in patients with vulvar lichen sclerosus (VLS) aged from childhood to perimenopause. Secondly, it was intended to compare these characteristics according to the menarchal status. METHODS: Patients less than 45 years of age with a diagnosis of VLS from January 2002 to June 2022 in 10 referral centers were included in this retrospective longitudinal study. The univariate analysis compared the dependent variables according to menarchal status. RESULTS: One hundred eighty-six patients met the inclusion criteria. At diagnosis, between 25% and 40% of premenarchal patients reported signs related to subepithelial hemorrhage. A significantly greater presence of bleeding ( p < .005), easy bruising ( p = .028), fissures ( p = .008), petechiae/splinter hemorrhages ( p < .001), and bleeding/blistering or open sores ( p = .011) was observed in premenarchal patients with respect to the postmenarchal group. The perineum ( p = .013) and the perianal region ( p < .001) were significantly more involved in the premenarchal group. Topical calcineurin inhibitors were more used in the premenarchal population ( p = .004), whereas vitamin E oil and moisturizers were more used in the postmenarchal population ( p = .047). CONCLUSIONS: Vulvar lichen sclerosus is a chronic condition that can cause vulvar changes that result in severe morbidity and affects sexual function and quality of life, even before menopause. Vulvar lichen sclerosus continues to be misdiagnosed in this population. This may lead to an average delay from symptom onset to diagnosis. Evaluating clinical manifestations of VLS in premenarchal and postmenarchal age allowed us to find different clinical characteristics between the 2 periods suggestive of the diagnosis.
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Objective

The main outcome of this study was the evaluation of clinical characteristics, comorbidities, and therapeutic approaches in patients with vulvar lichen sclerosus (VLS) aged from childhood to perimenopause. Secondly, it was intended to compare these characteristics according to the menarchal status.

Methods

Patients less than 45 years of age with a diagnosis of VLS from January 2002 to June 2022 in 10 referral centers were included in this retrospective longitudinal study. The univariate analysis compared the dependent variables according to menarchal status.

Results

One hundred eighty-six patients met the inclusion criteria. At diagnosis, between 25% and 40% of premenarchal patients reported signs related to subepithelial hemorrhage. A significantly greater presence of bleeding (p < .005), easy bruising (p = .028), fissures (p = .008), petechiae/splinter hemorrhages (p < .001), and bleeding/blistering or open sores (p = .011) was observed in premenarchal patients with respect to the postmenarchal group. The perineum (p = .013) and the perianal region (p < .001) were significantly more involved in the premenarchal group. Topical calcineurin inhibitors were more used in the premenarchal population (p = .004), whereas vitamin E oil and moisturizers were more used in the postmenarchal population (p = .047).

Conclusions

Vulvar lichen sclerosus is a chronic condition that can cause vulvar changes that result in severe morbidity and affects sexual function and quality of life, even before menopause. Vulvar lichen sclerosus continues to be misdiagnosed in this population. This may lead to an average delay from symptom onset to diagnosis. Evaluating clinical manifestations of VLS in premenarchal and postmenarchal age allowed us to find different clinical characteristics between the 2 periods suggestive of the diagnosis.

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MeSH descriptors

Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus

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vitamin e

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