Lichen sclerosus is a skin condition that makes patches of skin look white, thin and crinkly. It most often affects women on the skin around the vulva, but it can also affect the skin around the anus, and the foreskin of the penis in men.
Lichen sclerosus can be quite troubling as often there is no known cause. Thankfully there are treatments that are very effective for managing symptoms!
Lichen sclerosus affects roughly 1 in 80 women and can appear at any age, however, postmenopausal women are at a higher risk. While it can improve on its own, it is often a recurring, lifelong condition.
It can scar the vulva, making the vaginal opening smaller resulting in painful sex. It is also linked to vulvar cancer, and although it’s not a high risk, it is important that it is treated. Thankfully, there are options available for treatment that can be very effective for managing symptoms, so don’t hesitate to see your gynecologist for diagnosis.
Symptoms of Lichen Sclerosus
Mild cases of lichen sclerosus can present no symptoms, and may only be noticed during a Pap test. However it can cause some bothersome symptoms, such as:
• White spots on the skin
• Itching, which can be very bad
• Pain, particularly if the patches crack or split
• Very sensitive skin, such as on the clitoris
• Scarring, which in turn can make the vaginal opening, hood of the clitoris or vulva smaller
• Painful sex due to smaller vaginal opening
• Difficulty passing urine, or deflection of the stream due to fusion of the labia
• Bleeding or blistering (in severe cases)
The symptoms of lichen sclerosus are often mistaken for thrush, so if you are often itchy in the vulvar or anal area, be sure to see your doctor for diagnosis.
Causes of Lichen Sclerosus
It is currently unknown why lichen sclerosus occurs. About 1 in 4 people with the condition have an autoimmune disease such as thyroid disease, vitiligo, or pernicious anaemia, and therefore it is thought to be an autoimmune disorder whereby an overactive immune system attacks the skin rather than repairing it, causing inflammation. Hormone imbalances may also have something to do with it.
It is not contagious, and cannot be transmitted sexually. However, it can run in families, so be sure to ask your mother or sisters if they have it.
Diagnosis and Treatment of Lichen Sclerosus
Most cases of lichen sclerosus are fairly typical, and can be diagnosed upon inspection. However, a small sample (biopsy) of the affected skin may be taken for further examination. This is done under a local anaesthetic. A blood test may also be required to assess for an underactive thyroid gland, which is common in people with lichen sclerosus.
Treatment aims to help reduce itching, decrease further scarring, and improve the overall appearance of the patches on the skin. This is most commonly achieved with a steroid cream. These reduce inflammation and are usually prescribed to be used daily for three to four weeks, or until symptoms go away, then once or twice a week ongoing to help reduce the chance of recurrence. If treated at an early stage, the skin may return to normal. However, if the symptoms have progressed quite a lot, it may not be reversible, although the itchiness and inflammation will go away.
In some cases, surgery may required to remove any cancerous or pre-cancerous skin, and to remove scarring or adhesions that have made the opening of the vagina smaller, which can affect your ability to have or enjoy sex. As it is an ongoing condition, you will need regular check ups to monitor your symptoms.
Dr Bevan Brown is one of the most trusted gynaecologists in the Hills District. If you would like to book an appointment, please get touch in today. We will strive to give you guidance and compassionate care in every way possible.
