What threshold do you use to escalate to a multidisciplinary child sexual abuse evaluation when a child with newly diagnosed lichen sclerosus also has persistent/recurrent vulvovaginal symptoms despite appropriate lichen sclerosus therapy?  

Several variables need to be explored. What "appropriate" LS therapy has been utilized and, equally important, over what duration of time for this "newly diagnosed" case? Clobetasol ointment is to date the most effective treatment, but often requires months of continuous use; prescribing physicians ...