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Vulvar Lichen Sclerosus: Causes, Symptoms, and Treatment

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Sexual dysfunction occurs in many women with vulvar lichen sclerosus. Vulvar lichen sclerosus is a chronic inflammatory condition affecting the genital areas.

Written byDr. Shakshi Jain

Medically reviewed byDr. Raveendran. S. R

Published At August 3, 2023
Reviewed AtAugust 3, 2023

Introduction:

Vulvar lichen sclerosus is an inflammatory condition that affects the skin and genitals. It causes pain, irritation, itching, sexual dysfunction, and skin changes. The condition is expected in females at birth, postmenopausal, and premenopausal women. It is documented in both sex and all ages. The disease is contagious and may spread through sexual contact. It is more common in people who have family members with the condition. The disease is common in females leading to sexual dysfunction. Out of 500 women with vulvar lichen sclerosus, around 210 or sixty percent, were experiencing female dysfunction. The article mainly focuses on the relationship between vulvar lichen sclerosus and sexual dysfunction.

What Is Vulvar Lichen Sclerosus?

Vulvar lichen sclerosus is a disorder affecting the skin of the vulva, penis, or anus. It causes the skin to be irritated, thin, itchy, or discolored sores, and blisters also form on the genital area. Blisters rarely appear on the other body parts. If the condition is left untreated may lead to painful or difficult sex, bowel movement, and intimacy. The symptoms may return after treatment. If left untreated, there may be chances of squamous cell carcinoma (a type of skin cancer).

How Common Is Vulvar Lichen Sclerosus?

Vulvar lichen sclerosus is a rare condition. About two lakh people in the United States are suffering from the situation. Females at birth are more likely to develop the disease. Males can also be affected by the condition. It is most common in females aged between 40 to 60 who have gone through menopause and who have not started puberty.

What Are the Causes and Risk Factors of Vulvar Lichen Sclerosus That Lead to Sexual Dysfunction?

The causes of vulvar lichen sclerosus that can lead to sexual dysfunction in females are as follows:

  • Genetic Factors: The condition is more common in families.

  • Immune Symptoms Disorders: The autoimmune disorders in females in which the body's immune system may injure and attack the skin.

  • Hormones: Hormonal changes may lead to vulvar lichen sclerosus.

What Are the Signs and Symptoms of Vulvar Lichen Sclerosus?

Women with vulvar lichen sclerosus feel painful discomfort in the vulva and dullness. Some females have no symptoms. The typical sign and symptom is itching. It may interfere with sleep. The other symptom includes anal itching, bleeding, pain, anal fissures, and painful sexual intercourse. Painful sexual intercourse is due to the narrowing of the vaginal opening or cracking of the anal skin. Women with the condition may have thin, wrinkled, and white skin on the labia that extend around the anus. Blisters and sores develop in the genital area. Bruising with purple-colored regions may be seen. Fissures may be present around the labia, anus, and clitoris. Due to the fragility of the involved skin, sex or minor rubbing may lead to pain and bleeding.

Vulvar lichen sclerosus may progress, and the appearance of the genital area change. The inner and outer lips of the vulva stick together and cover the clitoris. The vaginal opening may become narrow. The fissures or cracks get thickened. The anal and genital areas can make sexual intercourse painful. The condition may affect the internal reproductive organs, including the uterus and vagina. The condition can affect other body parts, including the breast, neck, wrist, upper back, and mouth.

What Is the Relationship Between Vulvar Lichen Sclerosus and Sexual Dysfunction?

Vulvar lichen sclerosus is a chronic skin disorder that affects the external female genital organ, including the vulva. The condition may lead to pain, itching, and a burning sensation. Sexual dysfunction is a problem that occurs during sexual activity, including pain during sex, difficulty in becoming aroused, and difficulty in reaching orgasm.

Vulvar lichen sclerosus can lead to sexual dysfunction in women. The pain and discomfort due to the condition can make sexual activity difficult. The thinning and scarring of the vulvar tissue may make the woman become aroused and reach orgasm. The symptoms can be managed with medications. The treatment may improve sexual function.

How Can Vulvar Lichen Sclerosus Be Diagnosed?

The following methods can diagnose vulvar lichen sclerosus:

  • Physical Examination: The healthcare provider may physically examine the vulvar and anal areas. The doctor may check for the signs and symptoms.

  • Biopsy: The doctor may remove a small piece of the affected skin and send it to a laboratory to be examined with a microscope.

How Can Vulvar Lichen Sclerosus Be Treated?

The main goal of the treatment is to get rid of symptoms. The healthcare provider may prescribe medications for physical symptoms and support therapy for issues associated with the condition, like sexual dysfunction, problems with sex, and difficulty in sexual arousal. The patient may visit a healthcare provider for the reevaluation of the disease. The healthcare provider may recommend treatment based on the severity of the condition. The treatment measures are as follows:

  • Topical Medications: The doctor may prescribe corticosteroid creams and ointment for inflammation and itching. The estrogen cream may help to soften the skin around the vaginal opening. The steroid medication, including Clobetasol propionate, is effective in most women. The doctor may prescribe the daily application of the ointment for one to three months to reduce inflammation.

  • Immunosuppressive Medications: The doctor may prescribe immunosuppressive drugs that will help protect healthy cells.

  • Vaginal Dilators: The doctor may prescribe vaginal dilators to stretch the skin and restore normal function. The device is also used to prevent the recurrence of scarring.

How Can Vulvar Lichen Sclerosus Be Prevented?

Vulvar lichen sclerosus can be prevented in the following ways:

  • Keeping the vulva dry and clean may prevent skin infection and irritation.

  • Wear loose-fitting clothes because tight-fitting may irritate the skin.

  • Avoid irritants like soap, detergent, and perfumes irritating the vulva.

  • Quit smoking because smoking may increase the blood flow to the vulva.

Conclusion:

Vulvar lichen sclerosus is an inflammatory condition affecting the skin around the vulva. It may cause pain, burning sensation, itching, and scarring. Sexual dysfunction is a leading complication of vulvar lichen sclerosus, which harms the person's life. Psychological factors like depression and anxiety may lead to the condition. Treatment involves topical corticosteroids that may heal the symptoms. Physical therapy, counseling, and medication may limit sexual dysfunction. Support therapy and appropriate treatment may help people to manage symptoms and maintain a sex life.

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Frequently Asked Questions

Lichen sclerosus is an inflammatory condition affecting the skin and genital areas and causes discolored, patchy areas. The exact cause of vulvar lichen sclerosus is not understood. Studies have shown that it mostly occurs due to an overactive immune system, genetic factors, or previous skin irritation or damage.

Lichen sclerosus is a chronic inflammatory condition affecting any part of the skin. It can also affect boys or men and is mostly seen on the tip of the penis and foreskin. It starts as an itchy patch on the inner aspect of the foreskin and has an aggressive course. However, it can be cured in about 60 to 70 percent of men by long-term medical treatment.

The treatment for vulvar lichen sclerosus mainly depends on the severity of the condition. It can be treated by applying steroid ointment to the affected area twice daily. Phototherapy is recommended in some cases to reduce itching and inflammation. Surgical intervention is necessary if vulvar lichen sclerosus causes urethral strictures.

Some of the home remedies for vulvar lichen sclerosus include:


- Application of petroleum jelly, olive oil, or vitamin E cream to the affected area.


- Using mildly scented soaps and lotions.


- A warm bath is used to relieve burning sensations and pain.


- Natural lubricants such as organic aloe vera gel or coconut oil can be used during sexual activities to reduce friction and irritation.

Some of the complications of vulvar lichen sclerosus include:


- Urinary obstruction.


- Secondary infection due to chronic ulceration.


- Skin atrophy.


- Dyspareunia (painful sex).


- Scarring of the affected area.

Vulvar lichen sclerosus mostly affects the skin around the anus and vulva. It can cause pain, itchiness, soreness, and permanent scarring. It affects about one in 80 women of any age. However, it is commonly seen in middle-aged or elderly women. It is an uncommon autoimmune condition affecting the quality of life.

Vulvar lichen sclerosus can cause significant changes in the vulva, including disfiguration, and affects sexual function. Studies have demonstrated that a high rate of sexual dysfunction is seen in patients with lichen sclerosus. The anatomical changes and scarring resulting from this condition can cause sexual disturbances, pain, friction, and irritation during sexual activity.

According to various studies, vulvar lichen sclerosus does not affect pregnancy or delivery in most cases and does not indicate a cesarean section. However, if not treated appropriately, it can complicate the course of pregnancy. It is possible to get pregnant, manage the symptoms, and have a normal (vaginal) delivery with vulvar lichen sclerosus.

Consumption of calcium-rich foods and a low-oxalate diet can be beneficial during lichen sclerosus as they help reduce inflammation. These include apples, melons, avocados, fish, broccoli, green peas, basil, lettuce, plums, etc. Drinking adequate water and fluids can also help flush out the toxins from the system.

Stress can be a causative factor for the development of vulvar lichen sclerosus as stress releases cortisol, which can negatively impact the body. However, in some people, mental or emotional stress can also worsen the symptoms, resulting in flares and recurrence of vulvar lichen sclerosus.

Patients diagnosed with vulvar lichen sclerosus must follow up with their healthcare professionals every 6 to 12 months to monitor the skin changes or any side effects of the treatment. This must be carried on till patients experience good sexual function and reduction in symptoms and until no further alteration is required in treatment.

Various nonprofit organizations and healthcare groups are available to support people with vulvar lichen sclerosus. These groups carry out evidence-based education about the condition and its management to help people understand the disorder. It also helps motivate people and builds self-confidence, which provides mental support.

Vulvar lichen sclerosus can be diagnosed by a physical examination or evaluation of the affected skin. It appears as white, raised spots or patches on the anus and vulva and is associated with itching and pain. It can also affect other areas, such as the neck, upper back, chest, etc. A biopsy may also be preferred to rule out malignancy.

Vulvar lichen sclerosus cannot be prevented, but the following measures can reduce the symptoms of the condition:


- Wearing loose-fitting clothing.


- Avoiding cloth fabrics that irritate the skin.


- Use lukewarm water for baths and mild, unscented soaps and creams.


- Avoiding activities such as cycling, horseback riding, etc.


- Establishing a hygienic skincare routine.

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Dr. Raveendran. S. R from iCliniq
Dr. Raveendran. S. R

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