If you have ever experienced vaginal itching, soreness and discomfort down below, you may have put it down to thrush and popped to the chemist for some over-the-counter treatment. Let's be honest, how often do you really whip out a mirror and get a little more up close and personal with your vulva?
But if you’re experiencing the above symptoms and they’re not clearing up quickly, it’s worth taking a closer look. While it’s not a common condition one possible cause could be lichen sclerosus. The Association for Lichen Sclerosus & Vulval Health estimates it might affect one per cent of the global population, based on diagnosed cases.
We speak to Tania Adib, consultant gynaecologist at The Medical Chambers Kensington, to get the lowdown on lichen sclerosus signs, symptoms and treatment:
What is lichen sclerosus?
Never heard of it? You’re not alone. So what is it exactly? ‘Lichen sclerosus is a chronic inflammatory condition,’ explains Adib. ‘While it can affect any area of skin, it most commonly affects the skin around the vulva and the skin around anus.’
The cause of lichen sclerosus is still not entirely clear. However, the most common theory is that it’s caused by the body attacking itself.
‘It’s thought to be caused by an auto-immune condition, whereby the body produces antibodies against itself, creating changes in the skin,’ says Adib.
It’s important to know that lichen sclerosus is not an infection, nor is it sexually transmitted, so you can’t catch it from another person. It is not contagious or caused by poor hygiene.
Lichen sclerosus signs and symptoms
Lichen sclerosus can affect people of all ages but it is much more common in women over 50. It causes patches on the skin that are usually white, smooth or crinkled, itchy, easily bleed or hurt if rubbed or scratched.
These patches can appear anywhere but are most often around the vulva or anus (in girls or women) or on the foreskin and end of penis (in boys and men). For some sufferers this will cause pain when going to the toilet or having sex.
If you have lichen sclerosus as a woman, explains Adib, you will likely experience the following symptoms:
- Itching and discomfort around the vulva and/or anus
- The skin of your vulva becomes thin, shiny and smooth
- Loss of the folds of the labia (instead it will become one smooth layer)
- Scarring, adhesions and, in some cases, bruising
- Skin may appear white
Some of these symptoms will only become apparent upon visual examination, so it’s important to take a look between your legs, with the help of a handheld mirror.
Lichen sclerosus risk factors
Who does lichen sclerosus affect? While it can affect women of any age, you’re more likely to develop it as you get older.
‘Lichen sclerosus mainly affects post-menopausal women,’ confirms Adib. ‘It can also affect women in their early twenties, although it’s unclear why.’
Lichen sclerosus diagnosis
If you suspect you may be suffering with lichen sclerosus, it’s important to make an appointment with your doctor.
‘Lichen sclerosus needs to be diagnosed clinically,’ says Adib. ‘Your GP or gynaecologist will be able to make a diagnosis by looking at the affected skin. If there are any concerns about whether it’s lichen sclerosus, a biopsy may be taken, although it can usually be diagnosed simply by assessing the appearance.’
However, Adib reveals that, due to the itching and discomfort presented by lichen sclerosus resembling thrush, a correct diagnosis can often be missed.
‘Not all GPs are comfortable performing an examination based on the symptoms described,’ she says. ‘In fact, most women will go to their GP, say they are itchy below and be given a prescription for thrush medication. Because of this, a diagnosis can be delayed – for some women it can take years to receive a correct diagnosis.’
Lichen sclerosus treatment
While there is no cure for lichen sclerosus, symptoms of the condition usually respond well to treatment, meaning the condition can be well controlled. One of the most important ways to manage symptoms for women simply involves good basic vulval care. This includes:
✔️ Washing with water
✔️ Avoiding using soap
✔️ Gently drying the area after washing/urinating
✔️ Keeping the skin well moisturised or use a barrier treatment such as vaseline to the areas
✔️ Avoiding wearing tight clothing
✔️ Only wearing cotton or silk underwear
✔️ Don't scratch or rub the affected area or wear restrictive clothes - stockings may be better than tights.
Your GP may also prescribe a steroid ointment to ease symptoms. ‘The steroid ointment helps to reduce any inflammation,’ explains Adib. ‘For those women who can’t tolerate steroids or who don’t see improvements after steroid treatment, I would offer them laser or radio frequency treatment.’
Untreated lichen sclerosus can sometimes become scarred and tightened over time. This will cause discomfort potentially with going to the toilet, having sex and for men problems having an erection. Sometimes surgery is required to release the area.
Lichen sclerosus long-term health risks
While, in most cases, lichen sclerosus responds well to treatment, it’s important to keep a close eye on the area, as there is a link between the condition and the development of cancer on the vulval area for women or penis for men. The risk is low but it is a good idea to check yourself regularly and see a GP if you are worried.
‘We think about four per cent of women with lichen sclerosus go on to develop cancer,’ reveals Adib. ‘If you have been diagnosed, be vigilant. I ask my patients to regularly examine themselves with a mirror. Regular yearly check-ups are also important.’
⚠️ Self awareness is very important for your health, so self-examination of your genital area with a mirror is just as important as being aware of your breasts and other changes in your body. If something does not feel or look right, see your GP.
Further help and support
- Ask your GP for advice.
- Lichen sclerosus and vulval cancer UK awareness
- Find a sexual health clinic near you.
- Try Brook's Find a Service tool
- Call the national sexual health line 0300 123 7123.
Last updated: 19-02-2020