P095 Urinary incontinence and female genital lichen sclerosus

Abstract There is emerging evidence for an association between female genital lichen sclerosus (FGLSc) and urinary incontinence (UI), but this has not been investigated as extensively as in men. This study sought to explore this relationship further. Thirty patients with a clinical (and in some cases histological) diagnosis of active, untreated FGLSc and 30 healthy controls were recruited from clinics. Individuals who were immunocompromised were excluded. Cases and controls were assessed by a consultant dermatologist with vulval specialism. UI was assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Urinary Incontinence Short Form. The LSc Clinical Scoring System (CSS), comprising a patient-reported symptom score and a physician-reported examination score, was also recorded. Baseline characteristics of the groups were comparable with respect to known risk factors for UI: age, body mass index, parity, menopausal status, use of hormone replacement therapy and prior hysterectomy. Patients with FGLSc had significantly higher ICIQ scores than controls (median score 4 vs. 0; P = 0.01). The FGLSc group reported a higher frequency of urine leakage, with a median (interquartile range, IQR) score 1 (0–2) vs. 0 (0–1), P = 0.06; significantly larger volumes of urine leakage [median (IQR) score 2 (0–2) vs. 0 (0–2), P = 0.04] and a greater impact on quality of life [median (IQR) score 0 (0–5.5) vs. 0 (0–0), P = 0.002]. The median CSS patient-administered symptom scores were 6.5 (IQR 3.75–9) for pruritus, 5.5 (IQR 0–9) for pain, 2 (IQR 0–7) for burning and 6 (IQR 3–8) for dyspareunia. Subgroup analysis revealed that patients with FGLSc with severe or very severe UI scores reported significantly higher total symptom (pruritus + pain + burning) scores: median 23.5 (IQR 14.25–27.5) vs. 13.5 (IQR 5–20.5); P = 0.05. Dyspareunia was not included in the total score as the most symptomatic patients were unable to engage in intercourse. The CSS physician-reported examination scores for patients with FGLSc and severe or very severe UI were higher, although this did not reach statistical significance [median 4.5 (IQR 1.75–5.75) vs. 3 (IQR 2–4), P = 0.45]. This analysis provides further evidence for an association between FGLSc and UI. The high degree of comparability between confounding factors across case and control groups is an important strength. Use of an untreated population with active disease has facilitated the analysis of a possible link between incontinence severity and symptom severity. We emphasize the importance of screening for urinary incontinence in patients with FGLSc at clinical visits and assiduous management of UI in this population.