---
title: "Lichen Sclerosus vs GSM: How Clinicians Distinguish Them"
description: "Learn how clinicians differentiate lichen sclerosus from genitourinary syndrome of menopause through exam and biopsy for accurate diagnosis and treatment."
url: "https://www.myalloy.com/knowledge-base/how-can-clinicians-distinguish-lichen-sclerosus-from-the-genitourinary-syndrome-of-menopause-gsm-in-practice"
---

# Lichen Sclerosus vs GSM: How Clinicians Distinguish Them

> Learn how clinicians differentiate lichen sclerosus from genitourinary syndrome of menopause through exam and biopsy for accurate diagnosis and treatment.

## 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](https://www.youtube.com/watch?v=UWRNUxc_cFI&t=1388s) – why persistent symptoms should prompt further evaluation for conditions like lichen sclerosus.

[Watch video](https://www.youtube.com/watch?v=UWRNUxc_cFI&t=1388s)

- [Persistent GSM Symptoms and Further Testing](https://www.youtube.com/watch?v=UWRNUxc_cFI&t=1444s) – the importance of biopsy and specialist referral.

[Watch video](https://www.youtube.com/watch?v=UWRNUxc_cFI&t=1444s)

You can also read more about this on our blog: [Sex, Menopause & Cultural Differences](https://www.myalloy.com/blog/sex-menopause-and-cultural-differences).

If you are interested in evidence-based treatments for GSM, including vaginal estrogen, visit our [product page](https://www.myalloy.com/products) to learn more about what we offer at Alloy.


[Learn More](https://www.myalloy.com/solutions)

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This answer was created using the following resources:

- [Ask the Expert: Personalizing Menopause Care | Dr. Mary Claire Haver - Addressing Severe GSM Unresponsive to Treatment](https://www.youtube.com/watch?v=UWRNUxc_cFI)
- [Treating Lichen Sclerosis and Hormonal Changes | Dr. Rachel Rubin](https://www.youtube.com/watch?v=ZFqs33WFg7E)
- [Sex, Menopause & Cultural Differences | Alloy](https://www.myalloy.com/blog/sex-menopause-and-cultural-differences)

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