Mental Health and Sexual Wellness Impacts of Vulvar Lichen Sclerosus (VLS)

The chronic and often stigmatized nature of VLS contributes to heightened rates of anxiety and depression.

• Women with VLS are twice as likely to report clinical levels of anxiety and depression compared to the general population (Wilson et al., 2018).

• Many patients feel isolated due to dismissive attitudes from healthcare providers, which exacerbates feelings of frustration and invalidation (Brown et al., 2019).​

"Some women with vulvar lichen sclerosus have reported that they would choose to take years off their lives rather than continue experiencing the relentless and severe itching caused by the condition" (Gutiérrez Ontalvilla, 2022).

VLS often causes significant alterations to the vulva, such as thinning of the skin, scarring, and structural changes.

• These changes contribute to feelings of shame, embarrassment, and body image issues (Yıldız et al., 2020).

• 78% of women in one study associated their symptoms with a negative genital self-image, which directly impacted their self-esteem and quality of life (Yıldız et al., 2020).

Prolonged diagnostic journeys lead to frustration, hopelessness, and reduced trust in the healthcare system.

• Women with delayed VLS diagnoses reported feeling invalidated and unsupported by their providers (Brown et al., 2019).

Vulvar lichen sclerosus (VLS) is frequently misdiagnosed or underdiagnosed due to overlapping symptoms with other vulvar conditions and insufficient clinical awareness.

High Rates of Misdiagnosis: Many women endure significant delays in diagnosis, with VLS often misdiagnosed as recurrent vulvovaginal candidiasis or other inflammatory conditions.

• Lee et al. (2018) found that nearly 40% of women initially treated for candidiasis were later correctly diagnosed with VLS.

• These delays result in years of ineffective treatment, allowing disease progression and worsening symptoms (Krapf et al., 2020).

Challenges in Diagnosis: The subtle early presentation of VLS, such as faint whitish plaques or redness, is easily overlooked during routine gynecological exams.

• Dr. Gutiérrez Ontalvilla (2022) noted that providers often mistake early symptoms like itching for more common conditions, such as dermatitis or infections.

Under-diagnosis Due to Inadequate Examinations: Routine gynecological exams often do not include thorough vulvar inspections, further contributing to missed diagnoses.

• Willems and Veysey (2022) emphasized that fewer than half of general practitioners perform adequate vulvar inspections.

Delays Impact Emotional and Physical Health: Krapf et al. (2020) highlighted that women may wait over a decade before receiving a correct diagnosis, leading to significant physical and emotional consequences.