Clinical Scoring System for Vulvar Lichen Sclerosus Andreas R. Günthert, MD,* § Kathleen Duclos, †‡§ Boriana G. Jahns, MD,* Elke Krause, MD,* Esther Amann, MD,* Andreas Limacher, PhD, ‡ Michael D. Mueller, MD,* and Peter Jüni, MD †‡ *Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; † Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; ‡ CTU Bern, Bern University Hospital, Bern, Switzerland DOI: 10.1111/j.1743-6109.2012.02814.x 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 c 2 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 a  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. Günthert AR, Duclos K, Jahns BG, Krause E, Amann E, Limacher A, Mueller MD, and Jüni P. Clinical scoring system for vulvar lichen sclerosus. J Sex Med 2012;9:2342–2350. Key Words. Dyspareunia; Lichen Sclerosus; Sexual Pain Disorders; Vulva; Vulvar Intraepithelial Neoplasia Introduction L ichen sclerosus (LS) is a chronic localized lymphocyte-mediated inflammatory skin disease, which predominantly affects the anogeni- tal region and is more common in women, with extragenital lesions in 15–20% of cases [1–4]. The estimated prevalence of LS in a gynecology private practice in Baltimore was reported at approxi- mately 1.7% and it is usually diagnosed in peri- or postmenopausal women [5]. Many patients present with advanced disease at time of diagnosis. There- fore, the disease onset is likely to be at premeno- pausal stage in many women [5–7]. A minority of patients with LS present at childhood and the high rate of familial LS suggests a genetic contribution [8,9]. The etiology is probably multifactorial, but individual factors have not been established yet. The Koebner phenomenon (triggered disease progression and ulceration) is known to occur, so trauma, injury, and sexual abuse have been suggested as possible triggers of symptoms in genetically predisposed people [2,10]. Many inves- tigators reported on the association of LS and autoimmune disorders, especially thyroid disease, but extensive evaluation of immunological param- eters failed to show any consistent pattern [2,11– 13]. Lacking awareness for LS, in physicians and patients, and failure to examine the genital skin § Both authors contributed equally to this work. 2342 J Sex Med 2012;9:2342–2350 © 2012 International Society for Sexual Medicine