Clinical Scoring System for Vulvar Lichen Sclerosus

Abstract

Introduction Vulvar lichen sclerosus (LS) is a chronic inflammatory and mutilating disease, which goes often undetected for years. Advanced disease severely affects quality of life like sexual disorders and is also associated with an increased risk of vulvar cancer. Aim To develop and validate a patient-administered symptom score and a physician-administered clinical score for the diagnosis and evaluation of vulvar LS. Methods We included 24 patients with established LS diagnosis and 49 with other vulvar disease. The physician-administered score was based on six clinical features and the patient-administered score was a symptom-based four-item composite score. We determined inter-item correlations and internal consistency of both scores, and estimated sensitivities, specificities, likelihood ratios, and posttest probabilities for different cutoffs of the physician-administered score. Main Outcome Measures Characteristics of patients with and without LS were compared using χ2 and unpaired t-test as required. We then determined Cronbach’s alpha as a measure of the overall consistency of scores and calculated positive and negative likelihoods. Results Lack of redundancy of items (correlation coefficients < 0.90) and internal consistency (Cronbach’s α≥ 0.70) suggested that final composite scores were valid and yielded excellent power to rule in LS. Conclusion Scores may be useful for assessing symptoms of vulvar disorders, to ease diagnosis of LS and to evaluate treatment response over time.

The Impact of Vulvar Lichen Sclerosus on Sexual Dysfunction

“…In patients with advanced disease, the introitus may become narrowed resulting in painful sexual intercourse or preventing intercourse altogether. 6 The relationships between vulvar pain, sexual dysfunction, and LS are poorly understood. These symptoms are present for many women suffering from this disease.…”

Physician-administered clinical score of vulvar lichen sclerosus: A study of 36 cases

“…Cases were retrospectively subjected to physician-administered clinical score developed by Günthert et al [3] to validate the diagnosis. The clinical score was evaluated based on clinical findings and photographs of patients.…”

“…Each feature was graded on a 3-point Likert scale with grade 0 as normal findings, 1-moderate, and 2-severe changes [Table 1]. [3] Total score of ≥4 (range: 0-12) was considered VLS in the presence of typical symptoms. [3] Typical symptoms pointing toward diagnosis besides intractable itching and/or soreness were irritation, dyspareunia, dysuria, and fecal/urinary incontinence.…”

“…Günthert et al [3] has developed a physician-administered clinical scoring system to validate the diagnosis made clinically and to evaluate treatment response during subsequent follow-ups. This can be an important tool in an otherwise difficult to diagnose condition.…”

“…The purpose of our study was to assess the usefulness of physician-administered clinical score for the clinical diagnosis and evaluation of VLS in retrospect. To the best of our knowledge, this is the first study using the clinical score developed by Günthert et al [3] on the VLS patients.…”