Clinical Scoring System for Vulvar Lichen Sclerosus

Authors

  • Andreas R. Günthert MD,

    Corresponding author
    1. Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
      Andreas R. Günthert, MD, Department of Obstetrics and Gynecology, Inselspital, Effingerstrasse 102, 3010 Bern, Switzerland. Tel: +41 (31) 632-1010; Fax: +41 (31) 632-1205; E-mail: andreas.guenthert@insel.ch
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    • Both authors contributed equally to this work.

  • Kathleen Duclos,

    1. Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    2. CTU Bern, Bern University Hospital, Bern, Switzerland
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    • Both authors contributed equally to this work.

  • Boriana G. Jahns MD,

    1. Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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  • Elke Krause MD,

    1. Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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  • Esther Amann MD,

    1. Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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  • Andreas Limacher PhD,

    1. CTU Bern, Bern University Hospital, Bern, Switzerland
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  • Michael D. Mueller MD,

    1. Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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  • Peter Jüni MD

    1. Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
    2. CTU Bern, Bern University Hospital, Bern, Switzerland
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Andreas R. Günthert, MD, Department of Obstetrics and Gynecology, Inselspital, Effingerstrasse 102, 3010 Bern, Switzerland. Tel: +41 (31) 632-1010; Fax: +41 (31) 632-1205; E-mail: andreas.guenthert@insel.ch

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 χ2 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 α≥ 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.

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