What is it?

Lichen sclerosus (LS) is a skin condition that can cause itchiness and skin to look patchy, white and thick. It most often affects the skin around the vulva or anus. It can also cause scarring which a can lead to fusing of the labia which make the entry of the vaginal (introitus) smaller. Around 5% of women with LS will develop vulvar cancer during their lifetime.

How common is it?

Lichen sclerosus affects around one in 80 women. It can happen at any age, but is most common in middle-aged and elderly women. For most women, it is a lifelong condition.

What are the signs of lichen sclerosus?

Symptoms include:

  • chronic itchiness in the vulvar or anal area (which may go away and come back later)
  • skin that looks pale, thicker or crinkled
  • pain if the skin has split because of scratching

Skin affected by lichen sclerosus can also scar and join up with nearby skin. This can change the structure of your vulva – for example, your labia minora may appear flattened, your clitoris can become buried under its hood and/or the opening of your vagina may shrink. This can sometimes affect your ability to have and/or enjoy sex and can cause difficulty with urinating.

What causes lichen sclerosus?

We don’t know exactly- it is likely that some women have a genetic pre-disposition. It may be an auto-immune disorder, where your immune system becomes confused and attacks your skin instead of protecting it. Lichen sclerosus appears to be more common in women with other auto-immune illnesses such as thyroid problems or ulcerative colitis.

Lichen sclerosus is not sexually contracted and is not contagious. As long as it is not causing you pain, sex will not worsen your symptoms.

How is lichen sclerosus diagnosed?

Gynaecologists can diagnose lichen sclerosus by looking at your vulva. We usually take a small sample of your vulvar skin (called a biopsy) and send it away to a laboratory for testing.

How is lichen sclerosus treated?

Lichen sclerosis is a condition that often waxes and wanes. We have no permanent cure but you can control your symptoms when they flare up with more frequent treatment and keep your symptoms at bay with less frequent treatment. It is likely that you will always need maintenance treatment. We control your symptoms with steroids creams or ointments. If a vulvar cancer developed, surgery is usually required to remove it. If LS has caused significant fusion of your labia, and sex is painful, vaginal dilators may be useful to gently enlarge your vaginal opening over time. Rarely surgery may be required if sex remains painful or voiding is obstructed.

You will also need regular check-ups with your Gynaecologist to monitor your lichen sclerosus.

In summary

  • Lichen sclerosus is often mistaken for thrush so see your doctor if thrush treatment is not working!!
  • There are treatments that can help you successfully manage the symptoms.
  • Lichen sclerosus is not contagious.
  • Lichen sclerosus is a chronic condition that will likely require life-long management and surveillance by your Gynaecologist.