MonaLisa Screening Questionnaire Question Title * 1. Full Name OK Question Title * 2. Contact Information (this information will only be used to contact you if you qualify to participate) Name City/Town State/Province Country Email Address Phone Number OK Question Title * 3. How old are you OK Question Title * 4. What is your date of birth? OK Question Title * 5. Are you willing to travel to New York City for all 7 visits? (If needed, visit #1 and visit #7 can be performed in Washington, DC) Yes No OK Question Title * 6. Are you currently pregnant, breastfeeding or planning on conceiving in the near future? Yes No OK Question Title * 7. Are you sexually active? Yes No OK Question Title * 8. Are you currently using contraceptives? Yes, oral birth control Yes, IUD Yes, surgical (hysterectomy, bilateral oopherectomy, tubal ligation) Yes, vasectomy N/A, menopausal No Other (please specify) OK Question Title * 9. If you are sexually active and do not use contraception, would you be willing to use contraception throughout the duration of the study? If you become pregnant, you must withdrawal from the study. Yes No Already using contraception OK Question Title * 10. Have you been diagnosed with lichen sclerosus? Yes No OK Question Title * 11. Have you had a vulvar biopsy? Yes No OK Question Title * 12. On a scale from 0-10, how do you rate the severity of your vulvar itching (0 being none, 10 being extreme). OK Question Title * 13. Are you currently using any medications (systemic or topical) for your LS? If yes, please list all current treatments. Yes No If yes, please list all current treatments: OK Question Title * 14. If you are currently treating your lichen sclerosus, are you willing to stop ALL treatments 4 weeks prior to your first visit and throughout the duration of the study? If you treat your lichen sclerosus 4 weeks before visit 1 or at any point during the study, you may be disqualified. Yes No OK Question Title * 15. Have you been diagnosed with other vulvar dermatologic conditions (lichen planus, lichen simplex chronicus, psoriasis, intraepithelial neoplasia, or carcinoma)? If yes, please explain. Yes No If yes, please explain. OK Question Title * 16. Do you have any severe medical conditions? Yes No If yes, please explain. OK Question Title * 17. Do you have a generalized infection (bacterial, fungal or viral), or obvious localized infections in the vulvar area? Yes No If yes, please explain OK Question Title * 18. Do you have any ACTIVE sexually transmitted diseases? Yes No If yes, please explain. OK Question Title * 19. Have you been diagnosed with an immunocompromising disease (lymphoma, AIDS, Wiskott-Aldrich Syndrome) or have an uncontrolled malignant disease? Yes No If yes, please explain OK Question Title * 20. Do you have swollen lymph nodes (lymphadenopathy)? Yes No If yes, please explain OK Question Title * 21. Do you take systemic immunosuppressants? Yes No If yes, please explain. OK Question Title * 22. Have you taken or plan to take/use an investigational drug 4 weeks prior to the study or during the study? Yes No OK Question Title * 23. Do you have a history of substance abuse? Yes No If yes, please explain OK Question Title * 24. What is your menopasual status? Pre-meonpausal Peri-menopausal Menopausal Surgical menopause OK DONE