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The Vulval Skin Condition We Don't Talk About

Lichen schlerosis (or Lichen sclerosus) is an auto immune skin condition affecting the vulva, clitoris and anus in an upside down “keyhole” shape distribution.

Lichen schlerosis can take time to diagnose for a variety of reasons - one of which is that many vulva-owners may feel embarrassed presenting intimate problems to a doctor.

Lichen schlerosis can start non specifically as an itch. It can flare, remit and relapse. Importantly, if left undiagnosed and untreated, women with Lichen schlerosis are at increased risk of developing a skin cancer of the vulva.

Lichen schlerosis is named because this inflammatory skin condition can physically cause your vulva and perianal skin to become thickened, wrinkly/crinkled and white, aka schlerosis, and flaky, a bit like the appearance of lichen on a rock.

It can happen at any age, but lichen schlerosis is more common for women after menopause. Lichen sclerosis is not in any way contagious and cannot be sexually transmitted.

Symptoms of lichen schlerosis are related to itch, the inevitable scratch, and subsequent skin irritation and injury with associated skin barrier breakdown.

This itch-scratch cycle leads to pain, painful sex, scarring, skin fissuring, painful urination, skin bruising and bleeding - basically chronic genital irritation.

Lichen schlerosis can progress with small white spots coalescing to large white plaques, which can bury the clitoris. Lichen schlerosis combined with urogenital atrophy of menopause can also result in shrinkage of the vaginal opening, exacerbating sexual pain.

Diagnosis involves showing your vulva to a doctor (ideally a gynaecologist who will recognise lichen sclerosis by physical examination, combined with skin biopsy and microscopic examination).

Treatment for lichen sclerosis involves vulval care.  Moisturising daily (Protectility, Eternelle or Estradial in the water based cream is ideal for this), often also prescribed are topical steroids and prescription hormone replacement therapies. Breaking the itch-scratch-inflammation cycle and critically, protecting the skin is key.

Lichen schlerosis is a chronic condition that will not go away, but can be effectively managed with early detection and an holistic treatment plan.