Lichen Sclerosus
Vulval Lichen Sclerosus Diagnosis, Treatment and Ongoing Care
Lichen sclerosus is a chronic inflammatory skin condition affecting the vulva (external female genital skin) that can cause itching, irritation, soreness and changes in the appearance of the skin. It is a common cause of persistent vulval discomfort, particularly in postmenopausal women, but it can affect women of all ages.
Many women experience symptoms such as vulval itching, burning, skin splitting, discomfort during intercourse, or white patches on the vulval skin. Some women may have very mild symptoms or may not realise they have the condition until it is identified during a gynaecological examination.
Although lichen sclerosus is a long-term condition, appropriate diagnosis, treatment and regular follow-up can help control symptoms, protect vulval skin health and reduce the risk of complications.
What is Lichen Sclerosus?
Lichen sclerosus is a chronic inflammatory skin condition that most commonly affects the vulva (the external female genital skin) and the area around the anus. It can occur at any age but is more frequently diagnosed in postmenopausal women. It may also affect younger women and girls.
Lichen sclerosus causes changes in the vulval skin, including inflammation, thinning and increased sensitivity. If left untreated, it may lead to scarring, changes in the normal vulval anatomy, narrowing of the vaginal opening, discomfort during intercourse, and difficulties with urination.
Early diagnosis and appropriate management can help control symptoms, maintain vulval health and reduce the risk of complications.
Symptoms of Lichen Sclerosus
Symptoms can vary significantly between women. Some women experience severe discomfort, while others may have mild symptoms or no obvious symptoms.
The most common symptoms include:
• Severe vulval itching (the most common symptom)
• Vulval burning, irritation or soreness
• Pain or discomfort around the vulva
• Pain during sexual intercourse (dyspareunia)
• Dryness and sensitivity of the vulval skin
• Small cracks, splits or tears in the skin
• Bleeding or bruising after minor trauma
• Pain or burning when passing urine (dysuria)
• Anal itching or discomfort
• Changes in vulval appearance, including:
o White or pale patches of skin
o Thinning or fragile skin
o Loss of normal skin texture
o Tightening or narrowing around the vaginal opening
Some women may notice symptoms gradually over time, while others may experience sudden worsening of irritation or discomfort.
What Causes Lichen Sclerosus?
The exact cause of vulval lichen sclerosus is not fully understood. Research suggests that several factors may contribute to its development.
Autoimmune Factors
Lichen sclerosus is thought to have an autoimmune component, where the immune system becomes overactive and causes inflammation in the skin.
A significant number of women with lichen sclerosus also have other autoimmune conditions, most commonly:
• Thyroid disease
• Vitiligo (loss of skin pigment)
• Alopecia areata (patchy hair loss)
• Pernicious anaemia
The presence of these associations suggests that changes in immune function may play a role in lichen sclerosus.
Genetic Factors
Lichen sclerosus may occur more commonly in some families, suggesting that genetic factors can increase susceptibility. However, having a family member with lichen sclerosus does not mean that you will necessarily develop the condition.
Hormonal Factors
Lichen sclerosus is more commonly diagnosed in postmenopausal women, suggesting that reduced oestrogen levels may contribute to changes in vulval skin. However, the exact relationship between hormones and lichen sclerosus is not completely understood.
Skin Inflammation and Oxidative Stress
Ongoing inflammation and changes within the skin environment may contribute to the development and progression of lichen sclerosus.
Is Lichen Sclerosus Caused by Infection?
No. Lichen sclerosus is not an infection and is not sexually transmitted. It cannot be passed to a partner.
Although infections have been investigated as a possible contributing factor, there is currently no clear evidence that a specific infectious organism causes lichen sclerosus.
How is Lichen Sclerosus Diagnosed?
Diagnosis usually involves:
• A detailed discussion about your symptoms
• Examination of the vulval skin
• Assessment of any skin changes or scarring
• Review of your medical history and previous treatments
In some cases, a vulval skin biopsy may be recommended. This involves taking a small sample of skin for examination under a microscope.
A biopsy may be considered when:
• The diagnosis is uncertain
• The skin appearance is unusual
• Symptoms do not improve with treatment
• There are areas that require further assessment
Treatment of Lichen Sclerosus
Although there is currently no cure for lichen sclerosus, treatment is usually very effective in controlling symptoms and reducing inflammation.
Treatment may include:
Prescription Steroid Ointments
The main treatment for lichen sclerosus is a prescribed corticosteroid ointment. When used correctly, this can help:
• Reduce itching and irritation
• Control inflammation
• Improve skin condition
• Reduce the risk of scarring and complications
Your doctor will provide instructions on how often to apply treatment and how to maintain long-term skin health.
Vulval Skin Care
Gentle vulval care is an important part of management:
• Avoid scented soaps, bubble baths and perfumed products
• Use gentle, non-irritating cleansers if required
• Avoid excessive washing or scrubbing
• Use moisturising or barrier products when recommended
• Wear comfortable, breathable cotton underwear and avoid synthetic fabrics.
Managing Symptoms During Sexual Activity
Lichen sclerosus can sometimes cause discomfort during intercourse due to inflammation, skin sensitivity or scarring.
Management may include:
• Treating active inflammation
• Using appropriate lubricants
• Addressing vaginal dryness if present
• Discussing any ongoing pain or concerns with your gynaecologist
Long-Term Monitoring and Follow-Up
Lichen sclerosus is a long-term condition that usually requires ongoing care.
Regular follow-up appointments allow your doctor to:
• Monitor symptoms and skin changes
• Adjust treatment when needed
• Assess for scarring or anatomical changes
• Identify any areas requiring further investigation
Women with longstanding lichen sclerosus have an estimated 2-5% increased risk of developing vulval squamous cell carcinoma. Regular review and reporting any new or changing vulval areas promptly are important parts of management.
Seek medical review if you notice:
• A new lump or ulcer
• A persistent sore area
• Bleeding that is not explained
• A change in a previously stable area of skin
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When Should You See a Gynaecologist?
Call our clinic at 07 3219 6868 if you experience any of the following symptoms or if you have any other concerns:
• Persistent vulval itching
• White patches or changes in vulval skin colour
• Vulval burning or irritation
• Painful intercourse
• Recurrent skin splitting or bleeding
• Vulval discomfort that does not improve
• A change in the appearance of your vulva
A correct diagnosis is important because several other conditions can cause similar symptoms, including eczema, dermatitis, infections and other vulval skin disorders.