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

Una E Choi; Ryan C Nicholson; Pranjal Agrawal; Emelia Watts; Taylor P Kohn; Jaden R Kohn; Marisa Clifton

doi:10.1038/s41443-023-00793-3

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

Int J Impot Res. 2023 Nov 16. doi: 10.1038/s41443-023-00793-3. Online ahead of print.

Authors

Una E Choi¹, Ryan C Nicholson¹, Pranjal Agrawal¹, Emelia Watts¹, Taylor P Kohn², Jaden R Kohn³, Marisa Clifton⁴

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA. tpkohn@jhmi.edu.
³ Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA.

PMID: 37973860
DOI: 10.1038/s41443-023-00793-3

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.