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.


  • 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


Visual examination + biopsy by a medical practitioner.

There are three suggestions of the cause:

  1. Previous infection such as Borrella Burgdorferi, Epstein Barre Virus, Hepatitis C, Human Papilloma Virus (genital warts)
  2. Autoimmune
  3. 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)



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(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.


Image care of:

G, Kirtschig. (2016). Lichen Sclerosus-Presentation, Diagnosis and Management. Dtsch

Arztebl Int. 113(19):337-43.