Lichen Sclerosus is a chronic inflammatory skin condition that can affect both men and women typically around the genitals. It is not a sexually transmitted infection, and the cause is still unknown. The condition may lead to debilitating urinary and sexual dysfunction and is managed medically with women’s/pelvic health physiotherapy to manage symptoms.
Symptoms:
- Usually, the skin of the labia appears white and can be slightly cracked or wrinkled.
- Itching
- Painful sex (dyspareunia)
- Urinary incontinence
- Urinary frequency/Overactive bladder
Diagnosis:
Visual examination + biopsy by a medical practitioner.
There are three suggestions of the cause:
- Previous infection such as Borrella Burgdorferi, Epstein Barre Virus, Hepatitis C, Human Papilloma Virus (genital warts)
- Autoimmune
- Chronic irritation
Medical Management incudes:
- Topical corticosteroids – 1-2 times daily for 1 month, then reduced application for 2 months. Studies have shown this to be effective in 73 – 90% of cases. Early and aggressive treatment can halt or cause regression in symptoms
- Topical estrogen cream to counter the thinning of the skin caused by topical steroids
- Photodynamic therapy (light + drug)
- UVA1 (Ultraviolet light therapy)
- Not recommended: surgical removal of vulva tissue
Physiotherapy management:
- Ice/cold therapy for itching
- Pelvic floor programs for weakened muscles or overactive muscles from tension secondary to LS
- Urinary dysfunction management (including post void leakage which may be a factor in causing the condition. Post void leakage has been researched in men and linked to the onset of LS, research is yet to be done in women.)
- Management of painful sex
Risks if left untreated:
- The symptoms of itching, urinary and sexual dysfunction progress
- Scarring of the affected tissue
- Vulvar/vaginal atrophy
- Small amount, 3-6% can lead to squamous cell carcinoma (skin cancer)
References:
K, Fergus., A, Lee., N, Baradaran., A, Cohen., B, Stohr., B, Erickson., N, Mmonu., B, Breyer.
(2020) Pathophysiology, Clinical Manifestations, and Treatment of Lichen Sclerosus: A
Systematic Review. Urology, 135, 11− 19.
C, Christmann-Schmid., M, Hediger,. S, Gröger., J, Krebs . , A, Günthert., In cooperation with
the Verein Lichen sclerosus. (2018) Vulvar lichen sclerosus in women is associated with
lower urinary tract symptoms. Int Urogynecol J. 29(2):217-221.
G, Kirtschig. (2016). Lichen Sclerosus-Presentation, Diagnosis and Management. Dtsch
Arztebl Int. 113(19):337-43.
Streicher, L. (accessed 16/01/2023). Nothing to like about Lichen Sclerosus.
https://www.drstreicher.com/dr-streicher-blog/2015/9/nothing-to-like-about-lichen-
sclerosis
Image care of:
G, Kirtschig. (2016). Lichen Sclerosus-Presentation, Diagnosis and Management. Dtsch
Arztebl Int. 113(19):337-43.