Lichen Sclerosus: Why Vulval Itching Shouldn't Be Ignored

Vulval itching is something many women feel too embarrassed to mention, and it is easy to assume it is thrush or simply dry skin. Sometimes, though, persistent itching is caused by lichen sclerosus, a common skin condition that affects the vulva. It is very treatable, but it needs the right diagnosis and long-term care.

What is lichen sclerosus?

Lichen sclerosus is a long-term inflammatory skin condition. It most often affects the skin of the vulva and around the anus, although it can appear elsewhere on the body. It can happen at any age, but it is most common after the menopause, and it can also affect young girls.

The exact cause is not fully understood, but it is thought to be linked to the immune system. Importantly, it is not an infection, it cannot be passed on through sex, and it is not caused by poor hygiene. It is more common in people with other autoimmune conditions, such as thyroid disease.

Signs and symptoms

The most common symptom is itching, which is often worse at night and can be intense. Other signs include:

• white, shiny or crinkled patches of skin
• soreness, burning or splitting of the skin
• easy bruising or small blood blisters
• pain during sex
• discomfort when passing urine or opening your bowels

Over time, untreated lichen sclerosus can cause scarring. The inner lips of the vulva may shrink or fuse, and the entrance to the vagina can become narrower. Early treatment helps prevent these changes.

Why vulval itching should not be ignored

Many women try over-the-counter thrush creams for months before seeking help. If your itching keeps coming back or does not improve with treatment, it is important to see a doctor. A gynaecologist or dermatologist can usually diagnose lichen sclerosus by examining the skin, and a small skin sample, called a biopsy, may be taken if the diagnosis is uncertain.

Changes to the vulval skin can have several causes, and our page on vulval and vaginal lumps covers some of the others. Getting the correct diagnosis means you can start the right treatment sooner. It also rules out conditions that need different care.

Treating lichen sclerosus

The main treatment is a strong steroid ointment applied to the affected skin. It is usually used daily at first, then less often over a few months, and then as a maintenance treatment once or twice a week if needed. Used as directed, it is safe and very effective, and most women notice a big improvement in itching within weeks.

Simple skin care helps too. Use an emollient instead of soap, avoid perfumed products and wear loose cotton underwear. The British Association of Dermatologists provides helpful patient information on caring for your skin.

Lichen sclerosus and vulval cancer

Women with lichen sclerosus have a slightly higher risk of developing vulval cancer. The overall risk remains small, and good control of the condition with regular treatment appears to reduce it further. This is why ongoing monitoring matters, even when your symptoms are well controlled.

Check your vulval skin regularly with a mirror, and see your doctor promptly if you notice a lump, a thickened patch, an ulcer or a sore that does not heal. The Eve Appeal has useful information about the signs of vulval cancer and other gynaecological cancers.

Living well

Although lichen sclerosus cannot usually be cured, it can be controlled very well, and most women live normal, comfortable lives with the right care. Regular reviews, usually at least once a year, give you the chance to check that treatment is working and to raise any concerns. You can learn more about the conditions we treat and find out more about Mr Abu on our website.

If you have persistent vulval itching or have been diagnosed with lichen sclerosus and would like a specialist review, please contact our team to book an appointment. We will do everything we can to put you at ease.