Genital Lichen Sclerosus Mistaken for Child Sexual Abuse

Because of heightened awareness about sexual abuse, it is important for physicians to differentiate between genital lesions associated with abuse and those associated with "natural" disease processes. Lichen sclerosus is a disease of the skin most often found in the vulvar and perianal areas of postmenopausal women. It is less commonly seen in prepubertal female children and premenopausal adult women. Cases of lichen sclerosus have also been reported on the male genitalia, and it is an uncommon cause of phimosis in boys. One of the clinical manifestations of lichen sclerosus is cutaneous bleeding causing lesions resembling "blood blisters" or bruises.