Why is vulvar lichen sclerosus frequently underdiagnosed in women of color?
Vulvar lichen sclerosus is often missed in women of color for a mix of pretty frustrating but very real reasons. In the conversation with Dr. Sameena Rahman, she explains that a big part of the problem is how we’re taught to recognize this condition. Most medical atlases and training materials still rely on images of lighter skin. Lichen sclerosus often causes pale or white patches on the vulva, and when that shows up on darker skin it can look very different. Instead of prompting a doctor to think “lichen sclerosus,” it may get mislabeled as something else, like vitiligo.
She also points out that women of color are underrepresented in research on vulvar conditions. If studies don’t include enough diverse skin tones, clinicians don’t have the knowledge base they need to make accurate diagnoses. And then there’s the historical piece. Generations of justified mistrust toward the medical system make research participation harder, which means we end up with even less data on these conditions in women of color. It’s a cycle.
All of this contributes to underdiagnosis and undertreatment. Which matters, because untreated lichen sclerosus can cause scarring and architectural changes, and in a small percentage of cases it can progress to vulvar cancer. Dr. Rahman stresses how important it is to do a biopsy rather than relying on a visual guess.
If you want to hear her explain this in her own words, the chapter on lichen sclerosus in women of color is here:Lichen sclerosus & underdiagnosis in women of color.
And if your symptoms are more on the dryness, burning, itching, or painful sex side of the spectrum and you’re not sure whether that’s hormonal or something more, here at Alloy we see a lot of women get relief with localized estrogen therapy. Our estradiol vaginal cream is designed to treat those common menopausal changes:Estradiol vaginal cream.
Estradiol Vaginal Cream
$39.99
But if there’s any chance of lichen sclerosus, you really do need an in person exam and ideally a biopsy to confirm the diagnosis so you can get the right treatment.
This answer was created using the following resources: