Vulval concern

More secret women’s business – skin conditions that can affect the vulva

Just like the skin on other parts of the body, the skin around the vagina – known as the vulva – can be affected by various rashes, reactions and skin problems such as Lichen sclerosus (LS) and Lichen planus (LP). LS and LP are two skin problems that can be particularly problematic and require specialist medical care.

Both can cause itch, burning, stinging and discomfort with sex or Pap smears. Some women report burning discomfort with urination. Or, a feeling that ‘things are just not right down there’. Some women have no symptoms at all, and the changes are noted during a Pap test.

LS and LP have some overlapping features and can often be confused with other skin problems, such as post menopausal oestrogen deficiency changes (known as ‘atrophic vaginitis’), allergic reactions to creams or soaps or even recurrent thrush. Things can get a little tricky down there!

Skin Conditions of the Vulva – Menopause

Both conditions tend to be most common in women at the time of menopause. LS and LP can also occur in children and in men (around the end of the penis).

In a very small number of cases, these skin conditions can lead to skin cancer. Early and regular treatment reduces this risk.

Let’s talk about LS first, as this is the most common of the two vulval dermatological problems. It affects approximately 1:1000 women – so it’s more common that you might think.

Lichen sclerosus

‘Lichen’ is a medical term that refers to slightly raised growths on and in the surface of the skin. ‘Sclerosus’ refers to hardening of thickening of the skin.

So, skin of the vulva looks white, thin or thickened, or shiny and crinkly and sometimes has ulcerations (sores) and prominent small blood vessels. It loses elasticity and stretch.

About 10% of people will have patches of LS on other parts of their body – under the breasts or around the waist are common sites.

 

What causes lichen sclerosus?

Sometimes it is associated with autoimmune disease (such as psoriasis and thyroid problems). Sometimes there is a family history of autoimmune or skin problems). Low oestrogen levels in the skin also contribute. Trauma, or friction on the skin can also make the problem worse.

 

How do I know if I have Lichen sclerosus?

Women complain of itchiness, soreness and burning around the vagina.

The opening to the vagina can shrink and the inner lips flatten.

Some women don’t have any symptoms at all, or it can look like postmenopausal skin changes. Of course, women often have these two problems at the same time.

 

How is it diagnosed?

A doctor experienced in the management of vulval skin problems may be able to diagnose LS just by looking.

Sometimes, the changes are mild, so it’s not easy to 100% sure and a biopsy is needed. A biopsy is a simple procedure that allows a small piece of skin to be examined under a microscope by a pathologist.

 

How is Lichen sclerosus treated?

LS is a life-long condition and the aim is to suppress the autoimmune activity, replace local hormones and moisture with a combination of corticosteroid ointment, oestrogen cream and emollients.

 

Lichen Planus

Is a little different to LS, as it can affect the skin inside as well as outside of the vagina. Sometimes it’s not easy to tell if the skin changes are consistent with LS or LP. ‘Planus’ means flat.

There may be a white, or ‘lacy’ pattern on the skin around the opening of the vagina. There may be painful erosions, or areas of skin breakdown where is skin is red and moist.

Some women will also have a sticky-yellow green discharge.

Some people have LP on other areas of the body, such as the gums and the insides of the wrist, forearms and the ankles.

 

What causes Lichen planus?

LP is also an autoimmune problem, and is sometimes triggered by an infection or reaction to medication.

 

How do I know if I have it?

Itch is less common in LP. Mostly women describe soreness, burning and a feeling of ‘rawness’.

The opening to the vagina can shrink and the inner lips flatten.

 

How is it diagnosed?

Again, a doctor experienced in the management of vulval skin problems may be able to diagnose LP just by looking.

Or, you may need a biopsy done under local anaesthetic.

 

How is Lichen planus treated?

This can be a bit more complicated than LS. It can come and go. We use a mixture of corticosteroids, immune suppressing ointments and emollients.

 

Can I give Lichen sclerosus or Lichen planus to my partner?

No, LS and LP are not sexually transmitted. You can’t ‘catch it’, nor can you spread it to other parts of your body. Both can certainly make sex painful, and doctors advise avoiding sex until the skin has healed.

It can be helpful to bring partners along to an appointment so that they understand why sex is ‘off limits’ for a little while.

Dr Tonia Mezzini will monitor you closely through the initial three months of treatment and then devise an individualized management plan to keep the LS or LP suppressed.

Remember to avoid using soaps or perfumed body washes. Products from the QV, Cetaphil or Dermaveen ranges are best.

 

For more information go to:

 

Dr Tonia Mezzini is a member of the Australian and New Zealand Vulvovaginal Society and has been teaching other doctors how to help patients with vulval pain for years.  If you think that you may have LS or LP, make an appointment to see Dr Tonia Mezzini today.

Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with: