Lichen

Sclerosus

Program

Lichen sclerosus is a chronic condition affecting vulvar tissue — and it deserves more than symptom control. At IWish, our program follows ISSVD guidelines as the foundation, then goes further: restoring tissue health, preserving anatomy, and returning women to comfort, confidence, and quality of life.

Grounded in ISSVD Guidelines

Our program uses the International Society for the Study of Vulvovaginal Disease (ISSVD) standards of care as its clinical foundation — then builds upon them with advanced therapies unavailable at most practices.

Beyond Standard Care

Where conventional management ends, our protocol continues — integrating laser therapy, regenerative medicine, surgical correction, and hormonal optimization as a unified, phased approach.

Understanding the Condition

What Is Lichen

Sclerosus?

Restorative gynecologic surgery addresses the structural consequences of events outside your control — traumatic delivery, surgical complications, tissue atrophy, and scarring from inflammation. Unlike purely cosmetic procedures, these surgeries restore physiologic function: eliminating pain with intercourse, restoring tissue integrity, and repairing anatomical structures that affect daily quality of life.

Dr. Bahnmiller brings specialist-level anatomical expertise to every restorative procedure — understanding that these patients often carry years of discomfort, failed treatments, and dismissed concerns. This is where that ends.

  • Chronic Condition

  • Immune-Mediated

  • Vulvar Tissue

  • Elevated Cancer Risk

  • Treatable

  • ISSVD Guidelines

Side-by-Side

Standard Care vs.

The CSRH Protocol

The ISSVD standard of care provides an essential clinical foundation. At CSRH, we use it as a starting point — not a ceiling. Every category where conventional care stops short is an opportunity to restore what standard management leaves behind.

Category ISSVD Standard of Care CSRH Advanced Protocol
Primary Goal Symptom control, prevent scarring, reduce cancer risk Symptom control, prevent scarring, reduce cancer risk + Restore tissue health & function
First-Line Treatment Clobetasol Clobetasol + detailed patient education and technique coaching
Steroid Regimen Daily → taper Structured, individualized protocol with scheduled tapering
Application Guidance General instructions Detailed application coaching to maximize efficacy and compliance
Maintenance Intermittent as needed Structured maintenance protocol + Vulvoscopy surveillance
Adjunct Support Emollients Expanded support — barrier creams, compounding, lifestyle guidance
Laser Therapy Second-line consideration CO₂ laser (Monalisa Touch) Integrated into Phase 2 protocol
Regenerative Therapy Limited / not standard PRP and exosomes offered as part of tissue restoration phase
Sexual Function Under-addressed Core clinical focus Treated as essential, not optional
Anatomic Correction Late-stage surgical referral Preventative & restorative surgery available in-house
Cancer Monitoring Routine monitoring Enhanced surveillance education + structured vulvoscopy schedule
Overall Experience Disease control Concierge-level care Disease control + tissue restoration

Scar Revision

Our 6-Phase

Treatment Protocol

Phase 01

Stabilization

Clobetasol Therapy & Technique

The foundation of LS management. We prescribe clobetasol propionate with structured daily-to-taper dosing, combined with hands-on application coaching — ensuring maximum therapeutic effect and patient confidence in self-management.

  • Structured clobetasol dosing protocol

  • Application technique coaching

  • Barrier emollient support

  • Initial symptom tracking and benchmarking

Phase 02

Tissue Restoration

CO₂ Laser Therapy

Once inflammation is stabilized, fractional CO₂ laser therapy (MonaLisa Touch) is integrated to stimulate collagen remodeling, restore mucosal integrity, and reverse structural changes — going beyond symptom control to genuine tissue regeneration.

  • MonaLisa Touch fractional CO₂ laser

  • Collagen remodeling and tissue restoration

  • Improved elasticity and mucosal health

  • Reduced adhesion risk with early intervention

Phase 03

Refractory Disease

Tacrolimus & JAK Inhibitors

For patients who do not achieve adequate response with first-line therapy, we employ advanced immunomodulatory agents — including tacrolimus and JAK inhibitors — targeting the underlying inflammatory pathway driving disease activity.

  • Tacrolimus (calcineurin inhibitor)

  • JAK inhibitor therapy where indicated

  • Combination protocols for resistant disease

  • Close monitoring during advanced therapy

Phase 04

Structural Correction

Surgical Options

When LS causes anatomical change — clitoral adhesions, phimosis, labial fusion, or significant architectural distortion — surgical correction is available in-house. Early referral for surgical evaluation prevents progressive structural loss.

  • Clitoral adhesion release

  • Clitoroplasty and clitoropexy

  • Labial reconstruction and scar revision

  • Preventative surgery to preserve anatomy

Phase 05

Hormonal Optimization

Estrogen ± Androgen Therapy

Hormonal deficiency — particularly estrogen and androgen — worsens LS disease activity and impairs tissue resilience. Hormonal optimization is integrated as a clinical tool to support tissue health, improve treatment response, and restore sexual function.

  • Local and systemic estrogen therapy

  • Testosterone optimization where indicated

  • DHEA for mucosal and tissue support

  • Integration with ongoing LS management

Phase 06

Maintenance

Long-Term Care & Surveillance

Lichen sclerosus requires lifelong management. Our maintenance program includes structured steroid protocols, scheduled vulvoscopy surveillance for early detection of dysplasia or malignant change, and ongoing support for sexual health and function.

  • Structured long-term steroid maintenance

  • Vulvoscopy surveillance schedule

  • Cancer risk monitoring and education

  • Ongoing sexual function support

Our Approach

"At CSRH, we treat lichen sclerosus not just as a condition to control —

but as tissue to restore."

IWish Lichen Sclerosus Program · Dr. Daniel Bahnmiller, DO

What We Address

Care That Goes

Beyond Control

Tissue Health &

Restoration

Laser therapy and regenerative treatments that actively restore vulvar tissue integrity — not just slow its deterioration. CO₂ laser and PRP/exosomes work in parallel with medical therapy.

Sexual

Function

Sexual pain, loss of arousal, and orgasmic dysfunction caused by LS are core clinical targets — not secondary concerns. Every treatment plan addresses sexual health as a primary outcome.

Anatomy

Preservation

Preventative surgical intervention to address adhesions and structural changes before they become irreversible — preserving clitoral exposure, labial architecture, and vaginal access.

Cancer

Surveillance

Structured vulvoscopy monitoring and enhanced patient education around malignant transformation risk — with a clear protocol for escalation if concerning changes are identified.

Understanding the Condition

Concierge-Level

Disease Management

Most women with lichen sclerosus receive a prescription and a follow-up in six months. At IWish, the experience is fundamentally different — built around physician-led, structured, ongoing care that adapts as your disease does.

  • Physician-directed at every phase — no nurse-only management

  • Structured protocol with clear milestones, not open-ended monitoring

  • Vulvoscopy surveillance built into the maintenance phase

  • Sexual health treated as essential, not incidental

  • In-house surgical capability — no referral delays for structural correction

  • Integration with regenerative and hormonal therapies unavailable elsewhere

Ready to Start a

Real Treatment Plan?

Schedule a comprehensive Lichen Sclerosus evaluation with Dr. Bahnmiller — the Tri-Cities' only subspecialist offering the full spectrum of LS care from medical management through surgical correction.

Institute for Women's Intimate Surgery & Health

Expertise in Intimate Wellness & Surgical Precision.

Dr. Daniel Bahnmiller, DO

Women's Intimate Health & Cosmetic

Gynecologic Surgeon

Founder, IWish at CSRH

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A Division of Columbia Shores Regenerative Health