Lichen Sclerosus throughout Childhood and Adolescence: Not Only a Premenarchal Disease

Published:August 28, 2022DOI:


      Study Objective

      To determine the frequency of persistence of vulvar lichen sclerosus (LS) through the pubertal transition and assess if the symptomatology and exam findings differ by menarchal status at onset of symptoms


      A retrospective cohort study


      Academic tertiary care hospital


      Females aged 21 years or younger with a diagnosis of vulvar LS



      Main Outcome Measures

      Menarchal status at symptom onset, presenting symptoms, exam findings, persistence after menarche

      Results and Conclusions

      Of the 196 patients who met criteria, 141 were premenarchal and 55 postmenarchal. Of these 55, 36 had postmenarchal symptom onset, and the others had premenarchal symptom onset or LS diagnosis. Over the data review period, 26 patients were followed through the pubertal transition, and 10 (38.5%) had continued symptoms of LS. The premenarchal group (n = 141) was significantly more likely than the symptom-onset postmenarchal group (n = 36) to present with vulvar itching (70.2% vs 52.8%; P = .048), vulvar bleeding (26.2% vs 5.6%; P = .008), and bowel symptoms (16.3% vs 0%; P = .009). The premenarchal group was significantly more likely on exam to have subepithelial hemorrhages (24.8% vs 5.6%; P = .01). The postmenarchal group had more clitoral adhesions (25.0% vs 4.3%; P < .0001) and loss of labia minora (47.2% vs 2.1%; P < .0001). Thirteen postmenarchal patients presented with dyspareunia. This study suggests that premenarchal LS can persist after menarche in about 40% of adolescents and can initially develop in postmenarchal adolescents. Initial symptoms and exam findings differ on the basis of menarchal status. Continued surveillance is recommended.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Thomas RH
        • Ridley CM
        • McGibbon DH
        • et al.
        Anogenital lichen sclerosus in women.
        J R Soc Med. 1996; 89: 694-698
        • Powell J
        • Wojnarowska F:
        Childhood vulvar lichen sclerosus: an increasingly common problem.
        J Am Acad Dermatol. 2001; 44: 803-806
        • Sherman V
        • McPherson T
        • Baldo M
        • et al.
        The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study.
        J Eur Acad Dermatol Venereol. 2010; 24: 1031-1034
        • Dendrinos ML
        • Quint EH:
        Lichen sclerosus in children and adolescents.
        Curr Opin Obstet Gynecol. 2013; 25: 370-374
        • Lagerstedt M
        • Karvinen K
        • Joki-Erkkila M
        • et al.
        Childhood lichen sclerosus—a challenge for clinicians.
        Pediatr Dermatol. 2013; 30: 444-450
        • Smith YR
        • Quint EH
        Clobetasol propionate in the treatment of premenarchal vulvar lichen sclerosus.
        Obstet Gynecol. 2001; 98: 588-591
        • Bohm M
        • Frieling U
        • Luger TA
        • et al.
        Successful treatment of anogenital lichen sclerosus with topical tacrolimus.
        Arch Dermatol. 2003; 139: 922-924
        • Powell J
        • Wojnarowska F
        Childhood vulvar lichen sclerosus. The course after puberty.
        J Reprod Med. 2002; 47: 706-709
        • Smith SD
        • Fischer G
        Childhood onset vulvar lichen sclerosus does not resolve at puberty: a prospective case series.
        Pediatr Dermatol. 2009; 26: 725-729
      1. National Health Statistics Reports Number 146 ν September 10, 2020. U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics Trends and Patterns in Menarche in the United States: 1995 through 2013–2017 by Gladys M. Martinez, Ph.D.

        • Haefner HK
        • Aldrich NZ
        • Dalton VK
        • et al.
        The impact of vulvar lichen sclerosus on sexual dysfunction.
        J Womens Health (Larchmt). 2014; 23: 765-770