Abstract / Summary
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.