Clobetasol Propionate Versus Fractionated Carbon Dioxide Laser for the Treatment of Lichen Sclerosus

Inclusion Criteria: * Biopsy proven symptomatic vulvar lichen sclerosus * Ability to understand the study, accept randomization and logistically follow-up with scheduled visits * English Speaking Exclusion Criteria: * Known vulvar malignancy * Pregnancy or planning pregnancy or less than 3 months postpartum * Premenopausal * Current or prior diagnosis of any gynecologic malignancy * Previous pelvic radiation therapy * Allergy to topical steroid * Active Urinary Tract Infection (UTI), vulvar infection (candida, herpes, bacterial vaginosis, trichomoniasis or other infection) * Pelvic organ prolapse \> than Stage 2 * Treatment with systemic immunomodulators, topical calcineurin inhibitors (tacrolimus, pimecrolimus), or vaginal hormonal or vulvar topical steroid use within 2 months of enrollment * History of transvaginal mesh implant (excluding sling or sacrocolpopexy mesh) * IUD (Intrauterine Device) * Skindex-29 overall score \<21, below mildly impaired health related quality of life threshold