Lichen sclerosis is a chronic inflammatory skin disease that can affect children, women, and men. This inflammatory process typically affects the vulvar and anal skin, but can be seen throughout the body as well. This happens to be the most common vulvar skin issue with 1 in 30 women having been diagnosed. For this particular blog post, we will be focusing on lichen sclerosis affecting the vulvar tissue in women.
What are the Symptoms?
The most common presentation of lichen sclerosis is the presence of small white spots on the vulvar tissue that can also appear shiny and smooth. Most people will report itching, stinging, and burning at the tissue which can bruise and/or tear easily. Over time and when left untreated, the tissue can shrink and adhere to the underlying and surrounding tissues becoming thick with scars. In women, the labia minora can actually disappear, the clitoris can be covered with scar tissue, and the introitus (vaginal opening) can narrow. These symptoms can be quite painful and uncomfortable especially with intercourse and with contact of underwear or other material to the vulvar and perineal tissue.
What are the Causes?
Unfortunately, the cause of lichen sclerosis is unknown, but generally speaking, it is more common in postmenopausal women, leading researchers to think estrogen and other hormone levels play a role. There also seems to be a link genetically and found more often in women with overactive immune systems. It is usually diagnosed with appearance and biopsy.
How Can It Be Treated?
When diagnosed early, lichen sclerosis can be well managed. Patients will usually be prescribed a testosterone cream and a steroid cream like Clobetasol. Continued use of creams help improve the symptoms and avoid any further tissue damage by protecting the skin. These creams are about 90% effective in patients and are a great way to manage the diagnosis.
With the immune system playing a role, some patients have found great benefit in seeing a functional medicine doctor to determine what is causing the inflammatory response. Most of the time, inflammation is caused by gut health and diet, so having a provider who can help sort through your individualized diet can provide assistance in reducing your overall inflammatory response and, therefore, avoiding further tissue damage.
In severe cases and perhaps in those cases diagnosed later, cortisone injections, oral retinoid therapy, topical tretinoin, and even surgical options to correct the adhesions are possible. If left completely untreated, there is about a 5% risk of developing skin cancer. However, if caught early, symptoms are treatable and manageable.
How Can Physical Therapy Help?
Receiving any diagnosis “out of the norm” is never easy. It also does not make it easier knowing a diagnosis like lichen sclerosis affects tissue in a vulnerable and not well-discussed area of the body. That’s where we come in. As pelvic floor physical therapists, we aren’t going to change the tissue itself or reverse any damage that has happened thus far. Instead, we focus on mobility of the tissue to avoid any further adherence and make sure the introitus (or vaginal opening) and other vulvar structures can remain mobile and comfortable for penetrative intercourse and pelvic exams. There is also other muscle tension that can occur in surrounding areas that we address to improve overall mobility.
We know it’s not easy, but we are here to help and guide you through the process, while providing maintenance tips and tools for you to work with. Give us a call or seek out a pelvic floor provider near you to get started on the journey to feeling better.