Lichen Sclerosus: when itching, small tears or changes in your vulva are not “normal”

Many women come to see me after months — sometimes even years — of itching, burning, small tears or pain during sex.

They have tried thrush treatments, moisturisers, intimate washes… things improve for a few days, and then it starts all over again.

And sometimes, behind these symptoms, there is vulvar lichen sclerosus.

What is lichen sclerosus?

Lichen sclerosus is a chronic inflammatory condition that affects the skin of the vulva.

It can occur at any age, although it is more common after menopause. And importantly, it does not cause the same symptoms in every woman.

Some women experience intense itching with very few visible changes. Others have hardly any discomfort, yet when I examine them, there are quite noticeable changes.

So we should not judge the condition simply by how uncomfortable it feels.

What changes can it cause?

As well as itching, burning or irritation, you may notice:

• areas of skin becoming whiter;
• small tears or cracks that keep coming back;
• pain during sex;
• a feeling of tightness;
• changes around the clitoris;
• gradual changes or loss of the labia minora.
• 
  

Over time, if the inflammation is not properly controlled, lichen sclerosus can change the anatomy of the vulva.

This is why I often give my patients one very simple piece of advice:

Look at your vulva.

Not because I want you to constantly search for something wrong, but because knowing what your vulva normally looks like makes it much easier to recognise when something changes.

Do I need a biopsy?

Not always.

In many cases, lichen sclerosus can be diagnosed from your symptoms and a careful examination of the vulva.

Sometimes I recommend a small biopsy to confirm the diagnosis or because there is a particular area that I want to examine more closely.

The decision is individual.

How is lichen sclerosus treated?

There is one message here that I think is particularly important.

The main treatment for lichen sclerosus is a potent topical corticosteroid, most commonly clobetasol.

Many patients become concerned as soon as they hear the word “steroid”. But when it is used correctly and with appropriate medical follow-up, it is not the enemy. It is one of our most effective tools for controlling the inflammation and preventing further damage to the skin.

Treatment can then be adjusted according to how each woman responds.

Regenerative treatments may have a complementary role in selected cases or for certain consequences of the condition, but they do not replace the anti-inflammatory treatment of lichen sclerosus.

“Doctor, it doesn’t itch anymore. Does that mean I’m cured?”

I hear this question very often.

Lichen sclerosus is a chronic condition. We can keep it very well controlled, but that does not mean we should simply forget about it once the symptoms disappear.

Even if you feel completely well, your vulva should still be checked periodically.

Follow-up allows us to make sure the condition remains under control and to identify any new changes that may need further assessment. Lichen sclerosus is associated with a small increased risk of vulvar cancer, although the vast majority of women with lichen sclerosus will never develop vulvar cancer.

I do not want this information to create fear. I want it to encourage one good habit:

treatment, regular check-ups and knowing your own vulva.

If something changes, get it checked

If you have itching that keeps coming back, recurrent small tears, pain during sex or you have noticed changes in the appearance of your vulva, do not automatically assume that it is thrush, dryness or simply part of getting older.

Sometimes we just need to stop, take a proper look and put a name to what is happening.

And once we know what we are treating, everything changes.