Practice Gaps “Down There”: Failures in Education, Physical Examination, Recognition, Diagnosis, Therapy, Follow-up Care, and Cancer Surveillance in Lichen Sclerosus

Although lichen sclerosus (LS) in the vagina is rare,¹ this vulvar condition affects 1% to 3% of women. In this issue of JAMA Dermatology, Zendell and Edwards² report 2 new cases of LS. Although most patients are perimenopausal or postmenopausal, children are not spared. Because it is usually asymptomatic, patients are seen with advanced disease, having flattened labia minora, narrowed introitus, a scarred-down clitoris, and sexual dysfunction. This can occur as early as age 20 years, and therapy at this advanced stage is problematic.