"It itches a lot, but I've been told it's dryness."
"I get small cracks every time I have intercourse."
"Lately I notice my skin is different."
These are situations I see with relative frequency in consultation and which, in some women, end up leading to a diagnosis of lichen sclerosus.
Lichen sclerosus is a chronic inflammatory disease that mainly affects the skin of the vulva and the region around the anus. It can appear at any age, although it is more common after menopause.
What symptoms can it produce?
One of the best-known symptoms is vulvar itching, which in some women can become very intense. But it's not the only one.
There can also be burning, stinging, a feeling of irritation, repeating small fissures, skin fragility, or discomfort during sexual intercourse.
And importantly: not all women with lichen sclerosus have itching.
Sometimes the symptoms are mild and it is the changes we find during the examination that make us suspect the disease.
"I've noticed my vulva is changing"
This deserves special attention.
When the lichen remains active for a time, it can produce progressive changes in the tissues. Some women notice that the labia minora seem smaller, that the skin around the clitoris has changed, or that the vaginal entrance feels narrower.
Adhesions and scars can also appear.
These changes do not necessarily happen in all women nor do they evolve in the same way.
That's why I usually explain that lichen sclerosus is not simply a problem of itching or dryness.
Does it mean these symptoms are lichen sclerosus?
No.
Itching, burning, fissures, or pain during intercourse can appear in different vulvar diseases.
Recurrent candidiasis, certain dermatological problems, hormonal changes, or some forms of vulvar pain can produce symptoms that look similar.
That is why I do not recommend treating supposed "dryness" for months or repeating treatments for fungus without being clear about what is happening.
When should you consult it?
If you have persistent itching or burning, fissures that appear repeatedly, pain during intercourse, or have noticed changes in the skin or anatomy of your vulva, it is worth carrying out an assessment.
The diagnosis of lichen sclerosus is fundamentally clinical in many cases, and not all patients need a biopsy. The need to perform it will depend on the findings of the examination and each situation.
And if it is finally a lichen sclerosus, diagnosing it is only the first step. Treatment and follow-up are important to control the disease and prevent, as far as possible, its progression.
Would you like to expand this information?
You can expand this information in my patient guide.