Effective management of vulvar lichen sclerosus (VLS) requires collaboration across disciplines to address the multifaceted challenges of this chronic condition. By fostering clinical connections, professionals can ensure comprehensive care that addresses both the physical and psychological aspects of VLS.

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1. Partnering with Dermatologists and Gynecologists

• Specialized Expertise: Dermatologists and gynecologists play a central role in diagnosing and managing VLS, utilizing tools like dermoscopy to identify hallmark features such as keratotic plaques and depigmented areas (Borghi et al., 2016).

• Treatment Coordination: Close collaboration between these specialties ensures patients receive effective treatments, such as clobetasol steroid cream, and have consistent follow-ups to monitor progress and manage flares (Bradford & Fischer, 2010).

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2. Engaging Mental Health Professionals

• Psychological Impact: The emotional toll of VLS, including distress related to itching, pain, and changes in genital appearance, often requires mental health support. Referrals to psychologists or counselors trained in chronic condition management can help patients navigate these challenges (Yıldız et al., 2020).

• CBT for Pain and Itching: Cognitive-behavioral therapy (CBT) has been shown to reduce the psychological distress associated with chronic pain and itching, offering patients tools to reframe negative thought patterns and improve their quality of life (McCracken et al., 2014).

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3. Collaborating with Pelvic Floor Therapists

• Addressing Sexual Dysfunction: Many patients with VLS experience painful intercourse (dyspareunia) or reduced sensitivity due to scarring and clitoral hood adhesions. Pelvic floor therapists can provide targeted interventions to improve pelvic muscle function, reduce pain, and support sexual health (Gutiérrez Ontalvilla, 2022).

• Education and Empowerment: These professionals also play a key role in teaching patients strategies to manage discomfort and regain confidence in their physical and sexual well-being.

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4. Incorporating Autoimmune Screening

• Identifying Underlying Conditions: Given the strong association between VLS and autoimmune diseases like thyroid disorders, vitiligo, and type 1 diabetes, referrals to endocrinologists or rheumatologists for further screening may be warranted (Krapf et al., 2020).

• Holistic Care Approach: A multidisciplinary approach that includes managing autoimmune conditions can improve overall health outcomes and may reduce VLS flares (Bradford & Fischer, 2010).

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5. Connecting Patients with Support Networks

• Peer Support: Encourage patients to join trusted support groups or networks, such as the Lichen Sclerosus Support Network, to help them feel less isolated and more empowered in managing their condition.

• Ongoing Education: Share resources like Gutiérrez Ontalvilla’s book, So, I Have Vulvar Lichen Sclerosus. What Do I Do Now? (2022), which provides practical advice and guidance tailored to patient needs.

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6. Monitoring Long-Term Outcomes

• Regular Follow-Ups: Schedule regular appointments every 6–12 months to assess symptom control, screen for complications like scarring or cancer, and adjust treatment plans as needed (Günthert et al., 2012).

• Preventing Squamous Cell Carcinoma (SCC): Educating patients about the importance of adhering to treatments and attending regular check-ups is vital for early detection and prevention of SCC, a known risk in untreated VLS (Yıldız et al., 2020).

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Key Takeaway for Professionals

Collaboration between dermatologists, gynecologists, mental health professionals, pelvic floor therapists, and other specialists creates a robust network of care that addresses the diverse needs of VLS patients. By strengthening clinical connections, professionals can improve outcomes, enhance quality of life, and provide patients with the support they need to manage this chronic condition effectively.

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References

• Bradford, J., & Fischer, G. (2010). Long-term management of vulvar lichen sclerosus in adult women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50(2), 148–152.

• Borghi, A., et al. (2016). Dermoscopy as a diagnostic tool in vulvar lichen sclerosus. Journal of the American Academy of Dermatology, 74(5), 1017–1023.

• Günthert, A., et al. (2012). Clinical scoring system for vulvar lichen sclerosus to standardize diagnosis and therapy. Journal of Reproductive Medicine, 57(5-6), 223–228.

• Gutiérrez Ontalvilla, P. (2022). So, I have Vulvar Lichen Sclerosus. What do I do now? Independently published.

• Krapf, J. M., et al. (2020). Vulvar lichen sclerosus: Current perspectives. International Journal of Women's Health, 12, 11–20.

• McCracken, L. M., et al. (2014). The role of psychological flexibility in the context of self-management of chronic pain. Pain, 154(3), 624–630.

• Yıldız, S., et al. (2020). Vulvar lichen sclerosus and its effects on quality of life. International Urogynecology Journal, 31(3), 481–489.