Are You Living With Lichen Sclerosus?

Lichen sclerosus is a condition that many people experience but few have heard about. Because symptoms can overlap with other vulvar or pelvic pain conditions, diagnosis is often delayed, leaving individuals confused, uncomfortable, and unsure where to turn. This article aims to explain what lichen sclerosus is, common symptoms to watch for, and how a multidisciplinary care team, including pelvic floor physical therapy, can support symptom management and quality of life.

What Is Lichen Sclerosus?

Lichen sclerosus is a chronic, inflammatory skin condition that most commonly affects the vulvar and perianal skin. It causes changes in the skin’s appearance, texture, and sensitivity. During an active flare, the vulvar skin may appear thin, pale, bruised, or irritated, and individuals may experience pain or discomfort.

Lichen sclerosus is considered an autoimmune-related condition, and research shows that diagnosis is often delayed by 4–6 years due to symptom overlap with other causes of chronic pelvic pain. While it is more commonly diagnosed in postmenopausal individuals, lichen sclerosus can affect people of any age, including premenopausal adults and children.

Common Symptoms

Symptoms can vary from person to person and may fluctuate over time. Common symptoms include:

• Vulvar itching (often severe)
• Burning or irritation
• Pain with sexual activity (dyspareunia)
• Skin tearing or fissures
• Bruising or bleeding
• Scarring or changes in vulvar anatomy
• Vulvar pain or sensitivity
• Difficulty achieving orgasm

In children, symptoms may include itching, painful urination, constipation, vulvar discomfort, or bleeding. Early recognition of symptoms can support earlier diagnosis and treatment.

Diagnosis and Medical Treatment

Accurate diagnosis begins with finding a healthcare provider familiar with lichen sclerosus, as it is sometimes misdiagnosed as recurrent yeast infections or other dermatologic conditions. Diagnosis may be made through clinical examination and, in some cases, confirmed with a vulvar biopsy.

The gold standard medical treatment for lichen sclerosus is the use of ultra-potent topical corticosteroids, which help reduce inflammation, relieve symptoms, and prevent progression of skin changes. Other treatments, such as topical calcineurin inhibitors or platelet-rich plasma (PRP), may be considered in select cases under the guidance of a knowledgeable provider.

Because lichen sclerosus is a chronic condition, ongoing follow-up and individualized treatment plans are essential.

Additional Supportive Treatments

Research is ongoing into energy-based therapies such as laser therapy, photodynamic therapy, and focused ultrasound. While some studies show promise, more evidence is needed before these approaches can be widely recommended.

Beyond physical symptoms, lichen sclerosus can significantly impact emotional well-being, body image, and sexual confidence. Many individuals reduce or avoid intimacy due to fear of pain or skin damage. Support from a mental health professional particularly one specializing in sexual health can be an important part of care.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapists (PFPTs) specialize in the relationship between the pelvic floor muscles, connective tissue, and the nervous system. For individuals with lichen sclerosus, PFPT can help address secondary issues that often develop alongside skin changes.

Pelvic floor physical therapy may include:

• Gentle myofascial release and soft tissue techniques
• Scar tissue and connective tissue mobility work
• Education on relaxation strategies and pain management
• Guidance on vaginal dilator use when appropriate
• Support for returning to comfortable sexual activity

PFPTs also play an important advocacy role helping patients recognize concerning skin changes and encouraging referral to appropriate medical providers when needed.

Building the Right Care Team

If you suspect your symptoms may be related to lichen sclerosus, assembling a knowledgeable care team is key. This may include:

• A gynecologist or vulvar specialist
• A dermatologist
• A pelvic floor physical therapist
• A mental health provider with experience in sexual health

Early diagnosis and coordinated care can significantly improve symptom management and long-term outcomes.

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Articles and Resources:

1.     Krapf JM, Smith AB, Signa ST, Goldstein AT. Presenting Symptoms and Diagnosis of Vulvar Lichen Sclerosus in Premenopausal Women: A Cross-Sectional Study. J Low Genit Tract Dis. 2022. Jul1;26(3):271-275. doi:10.1097/LGT.0000000000000679.

2.     The Lichen Sclerosus support network: lssupport.net

3.     Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev. 2022: 10(1): 42-52. doi:10.1016/j.sxmr.2021.03.006.

4.     Govind V, Krapf JM, Mitchell L, et al. Exploring Pain-Related Anxiety and Depression in Female Patients With Provoked Vulvodynia With Associated Overactive Pelvic Floor Muscles.  Sex Med. 2020; 8(3): 517-524. Doi. 10.1016/j.esxm.2020.05.009

5.     Krapf, JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int. J Womens Health. 2020;12:11-20. Published 2020 Jan 15. doi:10.2147/IJWH.S191200