Lichen sclerosus

Lichen sclerosus (said ‘like-en skler-oh-sus’) is a skin condition that makes patches of skin look white, thickened and crinkly. It most often affects the skin around the vulva or anus.

It can be itchy, painful and cause permanent scarring. Four in 100 (or four per cent of)  women with this condition go on to develop vulvar cancer.

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.

What causes lichen sclerosus?

Unfortunately, we don’t yet know.

Some researchers think that lichen sclerosus 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.

How is lichen sclerosus diagnosed?

Your doctor can diagnose lichen sclerosus by looking at your vulva. Sometimes they might take a small sample of your vulvar skin (called a biopsy) and send it away to a laboratory for testing.

Unfortunately, lichen sclerosus is sometimes mistaken for thrush, which also causes vulvar itchiness. 

If your symptoms persist, you should see a skin specialist (a dermatologist) or women’s health specialist (a gynaecologist).

How is lichen sclerosus treated?

Unfortunately there is no cure or way to get rid of lichen sclerosus completely. There are however ways to reduce or lessen the symptoms so that you can live comfortably with it.

• Cortisone ointment applied to the vulva can provide relief and stop lichen sclerosus from getting worse. This is a lifelong treatment and you will need to apply cortisone regularly (often once or twice a week) even when you have no symptoms. Strong cortisone is safe to use on inflamed skin and will not cause the skin of your vulva to thin.
• Surgery to remove any cancerous or pre-cancerous skin. Surgery can also remove scarring or adhesions that cover the entrance to your vagina if these are affecting your ability to have or enjoy penetrative sex.

You will also need regular checkups with your doctor to monitor your lichen sclerosus. Let them know if you notice any new changes to your vulva.

Can I have sex if I have lichen sclerosus?

It is safe to have sex. You can’t give someone lichen sclerosus because it’s not a sexually transmitted infection or contagious.

You might find sex painful however, because scarring can make the vulvar skin (and vaginal opening) tight and more likely to split.

Talk to your doctor or a sexual counsellor if sex is painful or you are anxious about trying it again. Dilators that help to open the vagina and exercises that relax the surrounding muscles may help.

Things to remember

• Lichen sclerosus is often mistaken for thrush so see your doctor if you are often itchy in the vulvar or anal area.
• There are treatments that can help you successfully manage the symptoms.
• Lichen sclerosus is not contagious.

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