Lichen sclerosus is a chronic inflammatory skin disorder and autoimmune disease which causes thin white patches to develop on the skin. While rare, post-menopausal women are at the highest risk, and the condition typically presents itself in the genital and sometimes anal area, which is also known as vulvar lichen sclerosus.

Often misdiagnosed as a yeast infection or a result of menopause, vulvar lichen sclerosus can be the source of serious physical, sexual and emotional discomfort.

To explain how lichen manifests, our skin is made up of several layers – the outer layer known as the epidermis and the inner layer known as the dermis. For women who are experiencing lichen sclerosus, the epidermis becomes very thin, causing the stretchy fibers in your skin to break, causing its symptoms.

Signs and Symptoms

A common sign that you could be experiencing lichen sclerosus is the loss of pigmentation and architecture of the vagina. This can be diagnosed during a pelvic exam with your OBGYN. Women may also experience pain with sex and itching, which is a common sign that you’re losing your protective layer of skin.

Itching, however, can often be mistaken for a yeast infection which is why it’s important to ask your doctor for a vulvar biopsy since this is the only way to properly be diagnosed with lichen. Lichen sclerosus is often a painful condition due to the vulvar tissues thinning out and can make doing everyday things like wiping after you use the bathroom painful.

Early diagnosis of this condition through a vulvar biopsy is imperative as lichen can lead to serious medical issues including vulvar cancer. In fact, if not treated, 4-5% of patients will develop vulvar cancer. Lichen can also lead to irreversible scarring and certain anatomical changes if left untreated for too long.

A majority of providers do not routinely look at the vulva which is why vocalizing you’d like it checked is very important.

Incontinence and Lichen Sclerosus

In a recent study, it was found that 35% of women who have Lichen sclerosis also experience urinary incontinence. If not treated properly, it can lead to anatomy-based incontinence, meaning the incontinence doesn’t have anything to do with the bladder.

When you start having closure of the labia, and the closure starts happening over the urethra (where urine exits), urine will get stuck in that area or it can cause women to not empty out their bladder as much, leading to urgency, frequency, or overflow incontinence.

For women who are already experiencing incontinence, lichen can worsen symptoms since urine is a major irritant to the skin. If experiencing both lichen and urinary incontinence, it’s best to go to the bathroom more frequently and change incontinence pads regularly.

Are There Preventative Measures?

While there are no preventative measures women can take to stop lichen sclerosus from developing, as mentioned before, early diagnosis of the condition will be the best way to lessen the chances of developing vulvar cancer and permanent scarring.

It’s also important to note that lichen can develop at any age between your 20s into your 80s. People may even have it for years before getting a proper diagnosis and will only find out when they begin to experience some of its most notable symptoms.

Treatment

The great thing about treatment of lichen is that, with the proper medications, your vaginal tissues/damaged tissues are able to grow back. Clobetasol ointment is considered the gold standard when it comes to treatment of this condition and works to thicken and rebuild the structures and architecture of your genital area that was lost (typically targeting the top layer of cells that experience damage).

It is recommended to use this ointment twice a week, once a day, for about 4-6 weeks. Use can be extended to 8-12 weeks depending on the state of someone’s condition. However, since clobetasol is a steroid, it’s important to be careful to not overuse.

If used too often, the ointment can reverse its intended benefits and start to thin out the skin of the vagina. If you’re allergic to this medication, another option is to use steroid injections directly into the vulva.

Takeaways

Lichen sclerosus can be an often painful and uncomfortable condition, which is why having an open conversation with your healthcare provider to make sure you’re receiving a thorough pelvic exam is important and key to receiving an early diagnosis.

While being your own advocate, especially with your healthcare provider, can be scary, having a thorough exam will benefit your health in the long run and prevent conditions like lichen sclerosus from worsening.

When was the last time you had a thorough pelvic exam? Did you ask for it? Why? How do you take care of your pelvic health?