{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T07:06:13Z","timestamp":1788505573660,"version":"build-2803163510"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>Vulvar lichen sclerosus (LS) causes significant morbidity, and diagnostic delays of 5\u201315 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, <jats:italic toggle=\"yes\">P<\/jats:italic>=.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.<\/jats:p>","DOI":"10.1097\/og9.0000000000000099","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T21:00:26Z","timestamp":1753995626000},"page":"e099","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Barriers to Care for Vulvar Lichen Sclerosus"],"prefix":"10.1097","volume":"2","author":[{"given":"Leah","family":"McAleer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille M.","family":"Powers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Abraham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Rivera Dixon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Mauskar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,8]]},"reference":[{"key":"R1-20250731","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/1471-0528.16175","article-title":"Incidence of lichen sclerosus and subsequent causes of death: a nationwide Finnish register study","volume":"127","author":"Halonen","year":"2020","journal-title":"BJOG"},{"key":"R2-20250731","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jamadermatol.2015.0643","article-title":"Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women","volume":"151","author":"Lee","year":"2015","journal-title":"JAMA Dermatol"},{"key":"R3-20250731","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1001\/archderm.140.6.702","article-title":"Does treatment of vulvar lichen sclerosus influence its prognosis?","volume":"140","author":"Cooper","year":"2004","journal-title":"Arch Dermatol"},{"key":"R4-20250731","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/LGT.0000000000000673","article-title":"Risk of development of vulvar cancer in women with lichen sclerosus or lichen planus: a systematic review","volume":"26","author":"Vieira-Baptista","year":"2022","journal-title":"J Low Genit Tract Dis"},{"key":"R5-20250731","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.jaad.2024.11.047","article-title":"Race and appointment availability influence continuity of care for chronic inflammatory skin disease: a cross-sectional study of United States practice data","volume":"92","author":"Nicholas","year":"2025","journal-title":"J Am Acad Dermatol"},{"key":"R6-20250731","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1001\/jamaophthalmol.2018.0813","article-title":"Comparison of access to eye care appointments between patients with Medicaid and those with private health care insurance","volume":"136","author":"Lee","year":"2018","journal-title":"JAMA Ophthalmol"},{"key":"R7-20250731","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.jaad.2025.01.011","article-title":"Limited and variable access to dermatologists among Medicaid beneficiaries in the United States","volume":"92","author":"Dickerman","year":"2025","journal-title":"J Am Acad Dermatol"}],"container-title":["O&amp;G Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/og9.0000000000000099","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T21:00:27Z","timestamp":1753995627000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/og9.0000000000000099"}},"subtitle":["An Analysis of U.S. Specialty Clinic Access"],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/og9.0000000000000099","relation":{},"ISSN":["2994-9726"],"issn-type":[{"value":"2994-9726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]},"assertion":[{"value":"2025-05-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}