(190) Prescription Patterns in Women with Vulvar Lichen Sclerosus With and Without a Diagnosis of Sexual Dysfunction - A Claims Database Cohort Analysis
Authors: Choi U , Kohn T , Agrawal P , Clifton M 
Published: May 2023

Abstract

Introduction
Vulvar lichen sclerosus (VLS) often presents with intense pruritus and recurrent painful lesions, negatively impacting quality of life and, potentially, the ability to engage in sexual penetration. VLS treatment ranges from topical steroids to systemic antipruritic agents. No studies have yet characterized how concurrent sexual dysfunction impacts VLS treatment.

Objective
The objective of our study is to assess prescribing patterns in women with VLS with sexual dysfunction compared to women without a diagnosis of sexual dysfunction.

Methods
A US claims database network (TriNetX Research Network) was queried from 2009 to 2022. We compared women aged ≥18 with VLS (ICD-10: N90.4) and sexual dysfunction (R37 or F52) with women aged ≥18 with VLS but no diagnosis of sexual dysfunction. Outcomes of interest were prescription of opioids (N02A), topical steroids (DE200), vaginal estrogen (GU500), prednisone (8640) or intramuscular (IM) triamcinolone (10759), benzodiazepines (CN302), antifungals (D01) or oral fluconazole (4450), or antipruritic agents including hydroxyzine (5553), amitriptyline (704), gabapentin (25480), or citalopram (2556) within 6 months of the initial diagnosis of VLS. Propensity-matching between the cohorts age, ethnicity, race, type 1 diabetes (E10), vitiligo (L80), autoimmune thyroiditis (E06.3), alopecia areata (L63), pernicious anemia (D51.0), overweight and obesity (E66), type 2 diabetes (E11), hyperlipidemia (E78), essential hypertension (I10), and alcohol abuse (F10.10) was conducted.

Results
We identified 32,241 women with VLS that did not have concurrent sexual dysfunction (average age 59.5) and 416 women with VLS that had concurrent sexual dysfunction (average age 58.9). After propensity-score matching, the average age of women in each cohort was between 58 and 59 years old (Table 1). Women diagnosed with concurrent sexual dysfunction (n=416) were significantly more likely to receive vaginal estrogen prescriptions (Risk Ratio (RR) 2.00, 95% Confidence Interval (CI) 1.47-2.73), benzodiazepines (RR 1.39, 95% CI 1.00-1.942), and topical anti-inflammatory agents (RR 1.26, 95% CI 1.08-1.47) compared to an equivalent number of propensity-score matched women without a diagnosis of concurrent sexual dysfunction (Table 2). Prescription rates for systemic VLS treatments including oral prednisone or intramuscular triamcinolone (RR 1.06, 95% CI 0.56-1.98), opioids (RR 0.96, 95% CI 0.66-1.40), antifungals (RR 1.35, 95% CI 0.97-1.89), antipruritic agents hydroxyzine, amitriptyline, gabapentin, or citalopram (RR 1.35, 95% CI 0.94-1.93) did not significantly differ between women with or without concurrent sexual dysfunction.

Conclusions
Our results demonstrate that VLS treatment patterns differ with concurrent sexual dysfunction, with vaginal estrogen, benzodiazepines, and topical anti-inflammatory agents prescribed at higher rates to those with concurrent sexual dysfunction. Rates of prescriptions of opioids, antifungals, oral prednisone, intramuscular triamcinolone, hydroxyzine, amitriptyline, gabapentin, and citalopram were similar between the groups. Given the pruritic vulvar lesions associated with VLS, the low percentage (1.29%) of women with VLS and concurrent sexual dysfunction highlights a potential pattern of underdiagnosis; further study is required to investigate the relationship between VLS and sexual dysfunction.

Disclosure
No