A Survey of Experts Regarding the Treatment of Adult Vulvar Lichen Sclerosus
Bibliographic record
Abstract
OBJECTIVE: The objective of this work was to survey physician members and fellows of the International Society for the Study of Vulvovaginal Disease to determine current expert opinion regarding the management of adult vulvar lichen sclerosus. MATERIALS AND METHODS: A cross-sectional design was used. An electronic survey was emailed to all members and fellows of the International Society for the Study of Vulvovaginal Disease. Responses were analyzed using univariate methods. Subgroup analyses were performed to report treatment differences between gynecologists and dermatologists and between physicians in the United States and Europe. RESULTS: In total, 128 (42%) of 305 providers responded to the survey. Analysis was confined to the 114 physician respondents who treat patients with lichen sclerosus. Clobetasol propionate 0.05% is the most common first-line agent used in lichen sclerosus (85%). The most common second-line agents used are tacrolimus (39%), other topical steroids (28%), and intralesional steroids (13%). Most physicians (59%) start all patients with lichen sclerosus on drug therapy at an initial visit, regardless of symptoms. Dermatologists are more likely to treat all patients (both symptomatic and asymptomatic) than gynecologists (p < .01). Most physicians (64%) continue maintenance therapy in all patients. Gynecologists are more likely than dermatologists to treat only when patients are symptomatic versus using maintenance therapy (p = .03). Physicians practicing in the United States are more likely than those practicing in Europe to treat all patients with maintenance therapy (p < .01). CONCLUSIONS: Lichen sclerosus management varies among experts. Variations exist between physician specialties and between those practicing in different geographic locations. Uncertainty regarding optimal treatment remains, especially regarding long-term management.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".