Barriers to Care for Vulvar Lichen Sclerosus: An Analysis of U.S. Specialty Clinic Access

Abstract

Vulvar lichen sclerosus (LS) causes significant morbidity, and diagnostic delays of 5-15 years are common. This study uses a previously described secret-shopper model to evaluate access to specialized vulvar care in the United States. Of 246 clinics contacted, 165 (67.1%) were accepting new patients across 37 states. Median wait time was 55 days, significantly shorter for cash-pay clinics (15 days) than those accepting commercial insurance (63.5 days, P=.0014). Cash-pay fees averaged $860 for a new-patient appointment. Fifty-one clinics (20.7%) were closed or the clinician had retired, 18 (7.3%) were not accepting new patients, and 12 (4.9%) did not treat vulvar LS. Limited clinician availability, high costs, and long wait times highlight significant barriers to care, underscoring the need for clinician education and improved collaboration.