How can clinicians distinguish lichen sclerosus from the genitourinary syndrome of menopause (GSM) in practice?
Clinicians can distinguish lichen sclerosus from the genitourinary syndrome of menopause (GSM) by focusing on both clinical examination and, when necessary, biopsy. Here at Alloy, Dr. Sameena Rahman highlights that symptoms of GSM and lichen sclerosus can overlap, and sometimes both conditions coexist. However, there are key differences:
- Lichen sclerosus is an inflammatory skin condition, often with an autoimmune component, that causes architectural changes to the vulva, such as thickening of the skin, changes in pigmentation, regression of the labia, and sometimes the clitoris becoming hidden under thickened skin.
- GSM is primarily due to hormonal changes (estrogen deficiency) and typically presents with dryness, irritation, and sometimes superficial pain, but without the same degree of skin thickening or pigment changes.
If symptoms persist despite appropriate treatment for GSM (like vaginal estrogen), a thorough vulvar examination is essential. If lichen sclerosus is suspected, a biopsy may be needed to confirm the diagnosis, as untreated lichen sclerosus can lead to more serious complications, including a small risk of vulvar cancer.
For a deeper dive into this topic, check out these helpful video chapters:
- Addressing Severe GSM Unresponsive to Treatment – why persistent symptoms should prompt further evaluation for conditions like lichen sclerosus.
- Persistent GSM Symptoms and Further Testing – the importance of biopsy and specialist referral.
You can also read more about this on our blog: Sex, Menopause & Cultural Differences.
If you are interested in evidence-based treatments for GSM, including vaginal estrogen, visit our product page to learn more about what we offer at Alloy.
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