Objective: To evaluate treatment practises for postpartum individuals with genitourinary symptoms. Design: Cross-sectional survey. Setting: Online survey disseminated through postpartum/parenting groups and social media (March to May 2025). Population or Sample: Postpartum individuals within 24 months of delivery. Exclusion criteria included nulliparity, current pregnancy, prior genitourinary disorders, and incomplete responses. Methods: A 30-item questionnaire assessed demographics, lactation status, genitourinary symptoms, treatments offered and utilized, and quality of life (QoL; 0–100). Participants were stratified into exclusive lactation, non-exclusive lactation, and non-lactating groups. Quantitative data were analyzed with descriptive statistics, chi-square tests, and multinomial logistic regression (α = 0.05). Qualitative data underwent thematic analysis. Main Outcome Measures: Provider interaction/treatment practices for genitourinary symptoms. Results: Of 1,446 respondents (median age 36 years), 47.65% were exclusively lactating, 14.66% mixed feeding, and 37.69% non-lactating. Vaginal dryness was the most common symptom (exclusive: 100%; non-exclusive: 100%; non-lactating: 78.72%), followed by dyspareunia (57.04%, 50.00%, 36.33%). Functional impairments were prevalent with 76.34% of exclusively lactating participants reporting difficulty with sexual activity. Despite symptom burden, 63.81% were never asked about genitourinary concerns, and only 28.42% were offered treatment. Awareness of lactation-compatible therapies was limited (60.03% unaware). Vaginal estrogen and pelvic floor physiotherapy were most commonly recommended, but to fewer than 30% of symptomatic individuals. Lactation status was significantly associated with symptom presence and treatment patterns (p < 0.001). Themes highlighted severe pain, disrupted intimacy, and lack of provider support. Conclusions: Genitourinary symptoms during lactation are common yet inadequately managed. Care models should incorporate routine screening, provider education on lactation-safe therapies, and improved access to multidisciplinary interventions.

Objective: The objective of this study is to develop accepted definitions and grading scales for clitoral phimosis and clitoral adhesions. Design: Using a Delphi model of international vulvar experts, we attempt to reach consensus on definitions and factors included in grading scales. Setting: This was done through electronic surveys to accommodate the global reach. Population: Physicians with significant clinical and or research experience in vulvar dermatoses. Content experts were included from the fields of Dermatology, Gynecology and Urology. Methods: International content experts were invited to respond to two surveys on clitoral phimosis and clitoral adhesions. Individuals were deemed experts due to publications, international and national speaking engagements, and teaching on the topic of vulvar dermatoses. They were asked whether there is a need for definitions, the wording of definitions and the variables that should constitute a future classification. Main Outcome Measures: A priori, we decided that a mean score of 7 out of 10 (70%) would constitute a consensus. Results: The following statements gained consensus: 1) there is a need for a definition of clitoral phimosis and clitoral adhesions, 2) clitoral phimosis is defined as the inability to retract the clitoral prepuce to expose the entire glans 3) clitoral adhesion is defined as the tethering of the clitoral prepuce (clitoral hood) to the glans clitoris, 4) the prepuce (90%) and the size of the glans (70%) should be considered in a classification and 5) degree of phimosis should be described as mild, moderate, or severe and whether or not the prepuce is retractable. Conclusion: Unifying communication on clitoral phimosis and adhesions could help improve research and clinical management. Funding: There was no funding for this study.

Objective: Characterize the presentation of vulvar lichen scleorsus (LS) among premenopausal women. Design: Cross-sectional study. Setting: An international web-based survey distributed on social media support groups and in two urban gynecology offices specializing in LS. Population: A total of 503 premenopausal women with biopsy-confirmed vulvar LS between the ages of 18-50. Methods: Participants completed an anonymous 28-question web-based survey between January to March 2021. Main Outcome Measures: Symptoms, timing and accuracy of diagnosis, and presence of concomitant autoimmune conditions. Results: Symptoms reported to be most present and affect the individual were dyspareunia (68%; 44%) and tearing with intercourse or vaginal insertion (63%; 39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%), and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulvar fissures (72%) and labial resorption (60%), with fissures affecting the individual the most (48%). There was a 4-year delay in diagnosis with an average age of symptom onset of 27 years and average age of diagnosis of 32 years. Sixty-six percent of respondents initially received an alternative diagnosis, most commonly vulvovaginal yeast infection (49%). There is an increased incidence of hypothyroidism, vitiligo, pernicious anemia, and celiac disease. Conclusion: Premenopausal women with vulvar LS more commonly present with dyspareunia and tearing with intercourse, less often than vulvar pruritis. This condition should be considered and evaluated in women of all ages presenting with vulvar symptoms and sexual pain. Funding: None Keywords: lichen sclerosus; vulvar dermatoses; vulvar pruritis; dyspareunia

Objective To determine the efficacy of fractional carbon dioxide laser (FXCO2) therapy for vulvar lichen sclerosus (VLS). Design Prospective, double-blind, sham-controlled, randomized trial. Setting Clinic specializing in vulvovaginal disorders. Population Forty women with active VLS confirmed with biopsy who abstaining from topical and/or systemic treatments for at least 4 weeks. Methods Women were randomized in a 1:1 ratio to receive either five sham laser treatments or five FXCO2 treatments in a 24-week period. Pre- and post-treatment biopsies were obtained on all participants. Study participants, treating clinicians, and evaluating pathologist were blinded. Main Outcome Measures Primary: pre- and post-treatment biopsy Histopathologic Scale (HS) findings. Secondary: Clinical Scoring System for Vulvar Lichen Sclerosus (CSS) Results There was a 0.12 reduction (improvement) in HS from baseline in the active treatment group (95%CI = -1.01, 0.78, p=0.79) and a 0.06 increase from baseline in the sham treatment group (95%CI - -0.81, 0.92, p=0.90). The change in HS between the active and sham arm was not statistically significant (-0.17; 95%CI = -1.14, 1.06, p=0.78). There was a 6.82-point reduction (improvement) in the patients’ CSS from baseline in the active (95% CI = -11.28, -2.37, p= 0.004) and a 4.83-point reduction in the sham treatment group (95% CI = -9.16, -0.51, p=0.03). In the clinicians’ CSS, there was a 0.82 increase (worsening) in the active (95% CI = -0.46, 2.11, p=0.20) and a 0.28 reduction in the sham treatment group (95% CI = -1.53, 0.97, p=0.65). Conclusions. FXCO2 is not an effective monotherapy treatment for VLS