If you're concerned about discomfort or irritation in your intimate area, it could be vulval lichen sclerosus, a chronic skin disease that can impact not just your physical health but also your emotional and mental well-being. The condition is quite a common problem, and impacts a much larger number of women than you'd think. Women going through menopause or postmenopause need to be especially careful, because lower oestrogen during this time can disrupt the natural balance of your body, making you more vulnerable.
"There are several reasons why vulval lichen sclerosus can worsen or first appear during this stage of life," explains gynaecologist Dr Marta Sánchez-Dehesa. "One key reason is the significant drop in oestrogen levels, which causes changes in the vulval tissue.
"Ageing also plays a role, as the vulval skin becomes more fragile and thinner, making it more prone to tears, wounds and scars."
The discomfort can be so severe that it makes daily activities like walking or sitting difficult, and it can negatively affect a woman's overall quality of life, including her sexual health.
While lichen sclerosus itself is a non-cancerous condition, the long-term, chronic inflammation it causes can "increase the risk of vulval cancer, making early diagnosis extremely important," the expert warns.
© Getty ImagesSymptoms and causes
Vulval lichen sclerosus is characterised by thinning of the skin and the appearance of white, shiny patches. Scratching to ease itching can also cause red patches to erupt. "These changes can cause annoying symptoms like intense itching, burning, pain and discomfort during sexual intercourse or when urinating," explains gynaecologist Dr Marta Sánchez-Dehesa.
The gynaecologist explains that the main symptoms may include:
- Noticeable skin changes, including whitish and reddish patches
- Severe itching which frequently becomes worse at night, disrupting your sleep
- Painful sexual intercourse
- Without treatment, the condition can cause the labia minora of the vulva to shrink or disappear over time.
Contributing factors of the disease include autoimmune disorders as well as genetic predisposition and hormonal imbalances
The possible contributing factors of the disease include:
- Autoimmune disorders: Most studies suggest that lichen sclerosus is an autoimmune disease, where the immune system mistakenly attacks the cells of the skin and vulvar mucosa.
- Genetic predisposition: It's common for people diagnosed with lichen to have a family history of autoimmune diseases.
- Hormonal imbalance: The decrease in oestrogen during and after menopause can contribute to the development of the disease.
- Irritants or trauma: Using harsh soaps and detergents or wearing tight clothing can aggravate or trigger inflammation.
- Viral infections: While the relationship is not conclusive, in some cases, Lichen sclerosus has been associated with human papillomavirus (HPV) or hepatitis C.
© Getty ImagesWhy special care is needed during and after menopause
Because it impacts the vulva, many women are hesitant or embarrassed to talk about the disease. "Women are reluctant to discuss their intimate health issues, in general, but especially around menopause," relates Dr Sánchez-Dehesa. "When I inform my patients, who have come in to see me for lichen sclerosus symptoms or sometimes other issues, that it's actually very common, they often tell me that that their friends don't seem to have this problem - they're all doing great! This isn't something that a lot of people are discussing [with friends]; the patient usually isn't talking about it anywhere outside the doctor's office."
Early diagnosis and intervention are key to successful treatment. "Patients with a family history develop it more frequently, and menopause also increases the risk," says the doctor. "Prevention and early treatment can help avoid the symptoms."
© Getty ImagesHow vulval lichen sclerosus is treated
There is currently no cure, but vulval lichen sclerosus is manageable. There are several treatment options that can help relieve symptoms and improve your quality of life. These may include:
- Topical medications are the main line of treatment. For example, corticosteroids, or calcineurin inhibitors (non-steroid creams and ointments), to reduce inflammation and itching.
- Phototherapy, which involves exposing the affected skin to ultraviolet light.
This is a chronic disease that may require continuous care; but with proper treatment, many women can effectively control their symptoms and lead a normal life.
Keep in mind that:
- Using a lubricant during sexual intercourse can help prevent symptoms.
- Hormonal treatment [such as vaginal oestrogen] may be an option.
- Regenerative medicine treatments (laser, plasma, etc.) can also lead to improvement.
The most important step is to speak to your doctor and find the best treatment for you.
About the expert:
Dr. Marta Sánchez-Dehesa is head of gynaecology at HM IMI Toledo Hospital in Spain.
