Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin disease affecting mainly the genitals in men and women of any age. First-line treatment includes topical corticosteroids, circumcision is indicated in unresponsive patients or in phimosis. A retrospective study analyzed 55 men with LSA, of which 40% underwent circumcision. Of the operated patients, 83% used topical steroids before surgery and 68% continued after surgery, with an average steroid-free survival of 19 months. Resumption of steroid treatment after surgery was correlated with previous treatment (p = 0.043). Quality of life improved after circumcision and worsened with active treatment or phimosis (p = 0.002; p = 0.006). Circumcision improves quality of life especially in phimosis, although recurrences are common and local therapies are commonly used. The management of LSA should be personalized, combining medical and surgical approaches according to the severity and response of the patient.