Vulvar Lichen Sclerosus

What is Lichen Sclerosus?

Lichen sclerosus is a long-term skin disorder that mainly affects the genital skin. It can cause itching, burning, pain during sex, and tears in the skin. Lichen sclerosus is not an infection and is not contagious. It cannot be passed onto a sexual partner.

Lichen sclerosus usually starts around the age of menopause but may occur at any age. Although it mostly affects women, it can also occur in men and children. With this condition, the vulvar skin may appear thin, white, and crinkled. White bumps may be present with dark purple coloring. It can also have a shiny smooth surface.
What causes Lichen Sclerosus?

The cause of lichen sclerosus is unknown. It can be associated in some women with an autoimmune disease, such as thyroid disorders or vitiligo. Autoimmune diseases occur when the cells and proteins that the body uses to fight off infection start to damage the body’s own tissues and prevent their normal actions. It can be made worse by skin irritation, like itching and scratching, and any infection on open skin from yeast or bacteria.
What are the symptoms?

Some women have no symptoms and the diagnosis may be made when the area is examined for another reason. In about 10% of women with vulvar lichen sclerosus, white patches may be seen on the skin elsewhere. The common sites for this are on the back, waist area, and under the breasts.

Symptoms that may be seen or felt include:
  • Itching is the most common symptom. This can be severe and may disturb sleep.
  • Some women experience soreness and burning particularly with intercourse. Small cracks in the skin (fissures) and ulcers can occur as a result of scratching the skin. This can become very sore. If the anal skin splits, there can be pain with bowel movements.
  • The skin becomes pale and white in appearance. This may be patchy or involve the entire vulva extending down to the skin around the anus.
  • Some purplish/red areas may be seen on the white background. These are bruises due to tiny areas of bleeding into the skin, often because of scratching.
  • There may be scarring due to the loss of vulvar tissue (the inner lips) or shrinkage of the entrance to the vagina which can cause pain and interfere with sexual intercourse. It can rarely even cause pain with urination.
How is Lichen Sclerosus diagnosed?

The providers at Women’s Care of Wisconsin are familiar with this disease and may diagnose it by looking at the skin, seeing the usually characteristic appearance. The diagnosis is sometimes confirmed by taking a skin biopsy. This involves taking a small piece of skin, after numbing the skin with a local anesthetic, and then looking at it under a microscope. This is a simple procedure that can be done in-office at a Women’s Care location.
How is it treated?

There is no cure for lichen sclerosus but the symptoms can usually be controlled with a steroid cream. Strong steroid creams, such as Clobetasol Propionate or Halobetasol seem to be the most effective. Through the use of topical steroids, the appearance and texture of the vulvar skin can improve. However, if there is already scarring, these changes may not be reversed. Your Women’s Care provider will instruct you on how to safely use such creams. In general, a pea-sized amount is sufficient. Treatment should not be stopped unless advised by your provider, as this disease can recur or progress if off treatment. In addition, many women find that simple moisturizers, like plain petrolatum can provide extra relief.
All skin irritation should be avoided, as irritation will increase lichen sclerosus. Any infections from yeast or bacteria must be treated. It is preferable to gently clean the vulva only using one’s fingertips and warm water over the skin surface. A saline solution (a quarter of a teaspoon of salt dissolved in a cup of water) is also acceptable.

You may feel itchy at times and this may be worse at night. The itch/scratch response is normal but it is important to know scratching the area is harmful. It can damage the skin and keep symptoms going for quite some time. Along with a steroid ointment, distraction is some­thing you can do to help relieve the need to scratch. For example, if the itch is unbearable in bed, don’t lie there feeling uncomfortable and unable to resist scratching. Instead, get up and find something to do which occupies your hands and your concentration. When you feel the tension from the itch is reduced, then try to go back to bed. Hopefully, there will only be a short time before you begin to feel better. It is best to keep your nails short so scratching in your sleep will not cause too much damage.

If intercourse is painful, natural lubricants may help, or your provider may recommend physical therapy at PT Center for Women. If dryness is a problem and you are around the time of menopause, ask us about vaginal estrogens.

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