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Lichens Sclerosis

All Lichens are not created equally but today we are discussing Lichens Sclerosis (LS). Lichen sclerosis (LS) is a chronic, inflammatory skin condition that most commonly affects the genital and anal regions of both men and women (note that there are cases of lichen sclerosis on the upper body). It commonly presents as white, thin, and crinkled patches of skin that can cause itching, pain, and bleeding. In severe cases, the affected skin may become scarred and shrink, causing the genitals to become distorted. Sometimes, these patches may be surrounded by red or purple skin.

Presentation and symptoms of lichens might look like: hypopigmentation (white, thin, and crinkled patches) of skin on the genitals, itching and pain in the affected area, burning sensation while urinating/ dysuria, vaginal bleeding or discharge, and painful intercourse depending on the severity. Additionally, fusion of the clitoral hood, phimosis of the clitoris, resorption of the labia (smaller appearance or shrinkage) and narrowing of the vaginal opening can be present. It occurs in 1 in 70 women (According to ISSWSH- The International Society for the Study of Women’s Sexual Health) and is more commonly seen in postmenopausal women and older men. LS is also more likely to occur in people who have other autoimmune disorders, such as lupus or rheumatoid arthritis so medical history is hugely important for this diagnosis. The thinning of the skin post-menopause is consistent with decreasing estrogen and studies suggest that this decrease in estrogen levels that occurs during menopause may contribute to the development of LS. In addition, research has shown that topical estrogen therapy may be effective in treating LS in postmenopausal women. This therapy can help to thicken the vulvar skin and reduce inflammation, which can improve symptoms of LS.

Diagnosis is typically done via a combination of physical examination, medical history, and a biopsy. During a physical examination, a vulvar dermatologist/ gynecologist will look for the characteristic white, thin, and crinkled skin of lichen sclerosis, as well as any other symptoms such as itching or pain. They will note any additional areas of compromise including the anus and upper thighs.

The most common and effective treatment for LS is topical corticosteroids like Clobetasol, which can help to reduce inflammation and itching. This would be used until active LS has resolved not specifically when an individual no longer has symptoms. Surgery might be needed to correct clitoral phimosis and vaginal canal narrowing. It is important to consult a vulvar dermatologist/ gynecologist for proper diagnosis and treatment of lichen sclerosis. It is also important to note that compliance with the treatment and follow-up is critical for the best outcome

Treatment will also be multimodal as LS is complex and can be a challenging condition to manage affecting many factors in life- not only sexual performance and satisfaction but mental health as well. It is important that besides medication, these individuals see a pelvic floor physical therapist to ensure appropriate pelvic floor function, tissue mobility and appropriate stretch and lengthening of the muscles, education regarding vulvar health and irritants, as well as optimize sexual function and performance for those who are also sexually active. 

It is important to work with a qualified pelvic PT to develop an individualized treatment plan that is tailored to your specific needs and goals. Pelvic PT may also involve education about the condition and self-care techniques such as proper hygiene, skincare, and pain management. Additionally, a mental health therapist proves invaluable as individuals may go several years without symptoms being diagnosed and this can take a toll, especially if they were already not correctly diagnosed or if the diagnosis was overlooked.

At JMM Health Solutions, we treat clients with sexual health and pelvic pain concerns from a holistic lens using a mix of pelvic therapy and sex counseling to ensure that all goals for these clients are met. Reach out to us today to get scheduled at www.jmmhealthsolutions.com or call our office at 770-790-1460.

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