(191) A Systematic Review of Sexual Health Consequences among Women with Vulvar Lichen Sclerosus

Abstract

Abstract Introduction Lichen Sclerosus (LS) is a chronic, inflammatory skin condition that predominantly affects the vulva. This condition often leads to scarring involving the clitoris, labia minora, vaginal introitus, and perineum, leading to clitoral phimosis and introital stenosis. Women with LS are less likely to be sexually active than those without the condition. Studies have shown a high rate of sexual dysfunction in vulvar LS; however, the sexual effects of the condition are still poorly acknowledged. Objective To identify sexual health consequences of vulvar lichen sclerosus among women with vulvar lichen sclerosus through systematic review of available literature. Methods A systematic review of the literature was conducted on sexual health consequences of lichen sclerosus among women with lichen sclerosus. PubMed, MEDLINE, and Scopus were queried and results were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies are observational studies evaluating women of premenopausal or postmenopausal status with clinical or biopsy confirmed lichen sclerosus and sexual health, or randomized controlled trials or comparative studies utilizing a validated sexual function measure to evaluate sexual health prior to intervention among the same population. Manuscripts included must have been written in English from January 1991 to April 2022. Selection of studies was done by three independent reviewers and conflicts were resolved by discussion. Systemic reviews and committee guidelines were identified for references review. Results The search produced 683 references for title and abstract screening. Of these, 32 articles met criteria for full-text review. After full-text review, 20 studies met inclusion criteria and were evaluated. Three systematic reviews and three committee guidelines were identified and all references had been identified in the initial search. Eight publications yielded qualitative data regarding sexual health consequences of LS. A negative impact of sexual dysfunction was reported in 16-60% of affected women, and dyspareunia reported by 22-56.7%. LS is also associated with decreased sexual frequency and satisfaction, a negative impact on romantic relationships, and feelings of inadequacy as a sexual partner. Eight publications evaluated the Female Sexual Function Index (FSFI), and all demonstrated a central tendency less than 26.55 among those with LS. Four publications evaluated the Female Sexual Distress Scale (FSDS), and all demonstrated a score greater than 12 among women with LS. Two publications evaluated Female Genital Self-Image Scale (FGSIS) scores in women with LS, and both found decreased FGSIS scores compared to controls. Four publications evaluated the Dermatology Quality of Life Index (DQLI), with LS causing a small to very large impact on quality of life. The subcategory with the greatest impact of quality of life is sexual difficulties. One publication evaluated the Vulval Quality of Life Index (VQLI) in women LS, and found sexuality to be the second highest scoring subgroup. Conclusions The sexual health consequences of LS include sexual pain symptoms, all facets of female sexual function, sexual distress, negative genital self-image, and negative impact on romantic relationships. Women with LS experience a significant impact on quality of life, particularly in relation to sexual functioning. Disclosure No