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Involvement of vulva in lichen sclerosus increases the risk of antidepressant and benzodiazepine prescriptions for psychiatric disorder diagnoses

International Journal of Impotence Research (2023)Cite this article

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Abstract

While vulvar lichen sclerosus (VLS) causes intense pruritus, associated risks of mood disorders and prescription patterns and impact of concurrent sexual dysfunction are unknown. We queried TriNetX Diamond Network between 2009 and 2022, conducting three comparisons after propensity-score matching for demographics and relevant comorbidities: (1) women with lichen sclerosus (LS) sparing the vulva vs. women with VLS; (2) VLS patients who received treatment within 6 months of diagnosis vs. patients who did not and (3) VLS patients with vs. without sexual dysfunction. Outcomes included new depressive episodes, anxiety disorder, major depressive disorder (MDD), and prescriptions of antidepressants or benzodiazepines. After matching, VLS was associated with increased depressive episode [risk ratio (RR) 1.39], anxiety disorder (RR 1.93), and MDD (RR 2.00) diagnoses compared to LS sparing the vulva. Next, VLS treatment was associated with decreased risk of depressive episode (RR 0.60) and anxiety disorder (RR 0.72). Finally, concurrent sexual dysfunction was associated with increased benzodiazepine (RR 3.50), vaginal estrogen (RR 6.20), antipruritic agents (RR 3.90), and topical anti-inflammatory (RR 2.61) prescriptions. In conclusion, vulvar involvement is associated with increased risk of antidepressant and benzodiazepine prescriptions, and diagnosis of depressive episode, anxiety disorder, or MDD.

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Fig. 1: Flow chart of cohort construction.

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Data availability

The data used in this study are from the TriNetX deidentified database, which is available from TriNetX, LLC (https://trinetx.com/). Third-party restrictions affect availability of these data that prevent it from being made publicly available or redistributed. Researchers can access the TriNetX database through TriNetX, LLC.

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Una E. Choi, Ryan C. Nicholson, Pranjal Agrawal & Emelia Watts

  2. The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA

    Taylor P. Kohn & Marisa Clifton

  3. Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jaden R. Kohn

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Contributions

UEC and TK analyzed the data and UEC, RCN and EW wrote the article. PA, TK, JK, and MC provided substantial edits and guidance. All authors revised the article and approved the final manuscript.

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Correspondence to Taylor P. Kohn.

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Choi, U.E., Nicholson, R.C., Agrawal, P. et al. Involvement of vulva in lichen sclerosus increases the risk of antidepressant and benzodiazepine prescriptions for psychiatric disorder diagnoses. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00793-3

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