Vulvar Lichen Sclerosus
Lichen sclerosus (LS) is defined as vulvar skin that appears white in color and is thinner than normal. Although it can affect any part of the body, it is more commonly found on the skin of the vulva, foreskin or around the anal area. This vulvar condition can be found in any age group but it is most commonly found in postmenopausal woman. It can cause severe symptoms. Treatment is typically warranted and without it, many women can suffer severe consequences. Sometimes the skin can return to the normal coloration and aggressive treatment may decrease risk of formation of scarring and firm fibrotic tissues.
The exact cause of lichen sclerosus is not fully understood; however, it is not an infectious disease and woman have not caught this disease from a sexual partner. Some recent evidence may link lichen sclerosus to an over active immune system. Hormone problems may also play a role. There is also emerging support that genetics may also play an important role in getting the disease. In other cases, previous scarring and injury may have played a role.
Symptoms
Lichen sclerosus on your vulvar area can lead to troublesome symptoms. Often woman can complain of severe burning, tenderness, itchiness, discomfort and painful intercourse, or dyspareunia. According to an article in the European Journal of Dermatology, women with a mild case may not even be symptomatic at all.
The majority is however, and the skin may appear patchy white, tear easily, and in some cases may bleed or appear ripped or torn. The skin may be waxy in texture. At the start of the disease, lichen sclerosus may appear as small irregular shaped whitish patches that are on the vulva. It can be anywhere on the vulva including the perineum and clitoris. Several areas may join together and then the skin may appear flattened and wrinkled. Some clinicians describe the crinkled and wrinkled skin as “cigarette paper-like.”
As a result of the disease, the clitoris may become completely covered and buried. The labia may shrink in size. The vaginal opening can become smaller and painful to the slightest touch which can cause pain on insertion or painful intercourse.
There is a 3-6 percent risk of developing vulvar squamous carcinoma, so it is important for those who have been diagnosed with lichen sclerosus to have annual follow-up evaluations by a vulvar specialist. A vulvoscopy may be warranted to examine the vulvar tissues.
Diagnosis
If you have symptoms of lichen sclerosus and are concerned, a medical evaluation is warranted in order to diagnosis this condition. The health care provider will perform a complete history and physical examination along with a comprehensive genital examination. If the diagnosis is in question, a vulvar biopsy is typically recommended.
A vulvoscopy may also be recommended, where the vulvar tissue is swabbed with a solution. The provider will then look at the skin with a machine called a colposcope that magnifies the skin. After this review, a biopsy may be recommended. Some of the skin changes that may be seen include redness, increased or decreased pigmentation, scarring and changes in the anatomy.
Some specialists may do some further genital testing including vaginal pH to assess the acid base balance of the vagina, genital cultures to rule out sexually transmitted diseases, vaginitis, and a complete hormonal panel.
For a definitive diagnosis, a biopsy is warranted. After an informed consent form is completed, and the procedure is completely explained, a small area of the vulvar skin is cleansed and then injected with some local numbing medication. A small amount of vulvar tissue is then removed and sent to a special pathologist that specializes in dermatological conditions. A special analysis is performed on the tissue. Some providers will stitch up the small biopsy site, while others use other solutions to stop the bleeding.
Specialists
If you have lichen sclerosus, it is likely that you will require a vulvar specialist who is experienced in vulvar disease, vulvoscopy and new treatments for the disease. A lichen sclerosus specialist may be located at The National Vulvodynia Association (NVA) www.nva.org.
This organization has a comprehensive data base of health care providers who treat vulvar conditions, including lichen sclerosus. The site provides web addresses and additional information concerning specialty, type of practice and number of cases seen on a monthly basis. It can be searched by geographical area as well.
The International Society for the Study of Vulvovaginal Disease (www.issvd.org) may also be an excellent resource for up-to-date information, research and providers who specialize in vulvovaginal disorders. If you are suffering from sexual complaints associated or caused by lichen sclerosus, a good therapist or counselor who specializes in sexual pain may be located at the International Society for the Study of Women’s Sexual Health (www.isswsh.org) or American Association of Sexual Educators, Counselors and Therapists (www.aasect.org). The International Society for Sexual Medicine (www.issm.info) and the European Society for Sexual Medicine (www.essm.org) are also excellent resources.