Lichen sclerosus is a chronic inflammatory skin disease that has the potential to result in substantial patient morbidity and discomfort. If not identified and addressed early, lichen sclerosus has the tendency to progress to involve the anterior urethra and can result in significant and bothersome urethral stricture disease. Depending on the extent of urethral involvement and patient symptoms, management strategies range from simple topical ointments to major multi-stage urethral reconstructive operations. Herein, we describe the evaluation and management of male genital lichen sclerosus and provide a stepwise approach to treatment. However, although the treatment armamentarium for this difficult disease process continues to improve, our overall understanding of the pathogenesis of lichen sclerosus remains limited. Further research is required to better elucidate the underlying mechanisms and pathways involved to learn how we may be better able to control and prevent lichen sclerosus as a whole.