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FAQ-vulvovaginal disorders, Andrew Goldstein, Vulva, pain during sex, vulvodynia, vular vestibulitis, vestibulitis, lichen sclerosus
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vulvodynia, vulvar vestibulitis, VVS, vestibulitis, DIV, pain during sex, endometriosis, dyspareunia, lichen sclerosus
vulvodynia, vulvar vestibulitis, VVS, vestibulitis, DIV, pain during sex, endometriosis, dyspareunia, lichen sclerosus
Research Studies

Dr. Andrew Goldstein, the Director of the Centers for Vulvovaginal Disorders, was recently interviewed by Dr. Tim Johnson for ABC News' 20/20 on a story about sexual pain. Click on the link above to see the entire segment. 
Dr. Andrew Goldstein is Medical Director of OurGyn.com, a website devoted to all aspects of women's health. click the link to be directed to this very informative and awarding winning website. Please visit our other websites: HisandHerHealth.com, RedHotMamma.org, BermanSexualHealth.com, and Menopausewise.com


 Lichen Sclerosus 

Lichen sclerosus is a chronic inflammatory disorder or the anogenital skin that affects approximately  one  in  seventy  women. The word "lichen" mean "thick and scaly" and the word "sclerosus" means "scarring."   The average age of diagnosis is 51 years old, but 15% of females with lichen sclerosus are pre-pubertal girls.  Lesions on other areas of skin may occur in 11% of patients. While the cause of  lichen sclerosus is has not been completely elucidated, it is most likely that lichen sclerosus is an auto-immune disorder as it is highly associated with other auto-immune disorders including auto-immune thyroid disease, alopecia areata, viteligo, pernicious anemia, and  lichen planus. In addition, there are high levels of  circulating auto-antibodies in patients with lichen sclerosus. Women with lichen sclerosus have a 4 - 6% risk of developing vulvar carcinoma. Lichen sclerosus has been found in greater than 60% of cases of squamous carcinoma of the vulva.

While some patients are without symptoms, most women have itching, vulvar pain, and or pain with intercourse. One study that focused on the impact that lichen sclerosus has on a women's sexual satisfaction showed that women with lichen sclerosus were found to be  less likely to be sexually active (vaginal intercourse, oral intercourse, and masturbation) than control groups. Furthermore, 79% of women with lichen sclerosus reported chronic vulvar pain.

Clinically, on examination there are white, thin areas of skin that may have the appearance of "cigarette paper. There can be areas of hemorrhage under the skin. Due to the chronic inflammation associated with this condition, there can be significant scarring such as narrowing of the opening of the vagina, complete destruction of the labia minora, and the clitoris can be scarred over (phimosis).  

           A biopsy specimen should always be obtained to confirm the diagnosis of lichen sclerosus.  In addition, it is essential to obtain the biopsy prior to starting treatment as the characteristic pathological changes can be altered with treatment.

   The mainstay of treatment is ultra-potent topical corticosteroid ointment, such as clobetasol propionate ointment applied daily until all active disease has resolved. Patients should be seen two to three month after initiating therapy to confirm improvement.  Areas of ulceration that do not resolve after appropriate treatment with corticosteroids must be biopsied to rule out precancerous pr cancerous growths  Once improvement has been demonstrated, the frequency may be tapered down to once or twice per week.  It is important to remember this is a chronic disease and that treatment only when symptomatic is not sufficient as there can be active disease without symptoms.  The Centers for Vulvovaginal Disorders are currently conducting a clinical trial of a new medication to treat lichen sclerosus.


Click here to view a photo gallery of photos of lichen sclerosus ( PLEASE NOTE -  there are explicit photos of  the genitals of woman and these images are not appropriate for anyone under the age of 18.)



Dr. Andrew Goldstein and Dr. Marianne Brandon's book Reclaiming Desire: 4 Keys to Finding Your Lost Libido outlines their highly effective holistic approach to treating decreased sexual desire. Inside you'll find an exclusive self-test to assess physical, emotional, intellectual, and spiritual health--the four cornerstones of a healthy sex drive. In addition, there is essential information on how major life events such as pregnancy, menopause, and divorce can affect a woman's sexual health. The updated paperback edition was recently published.  Click here to read an excerpt. Go to Amazon to purchase a copy.

The Centers for Vulvovaginal Disorders
3 Washington Circle NW, Suite 205
Washington, DC 20037
Phone: (202) 887-0568

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