Not All Vulvar Itching Is Yeast: The Diagnosis and Management of Lichen Sclerosus

Vulvovaginal symptoms are a very common presenting complaint in settings that provide women’s healthcare. Patients often assume they are experiencing itching or discomfort because of known conditions such as yeast infections. They may self-treat, resulting in a delay in seeking care or being misdiagnosed via phone or telehealth without ever having a physical exam. Vulvar lichen sclerosus (LS) occurs in 1%–3% of women and can cause significant vulvar itching and skin changes. Chronic vulvovaginal symptoms such as itching warrant a focused health history, thorough physical examination, and appropriate laboratory and diagnostic tests so that all potential differential diagnoses, including LS, can be considered. This article provides an overview of the assessment, diagnosis, treatment, and long-term management of vulvar LS.