Vulval lichen planus (LP)
Cancer of the vulva can affect any part of the external female sex organs. It is sometimes also called vulvar cancer.
Lichen planus (LP) is a skin condition. When it affects the skin of the vulva, it is known as vulval LP.
The vulva is the name given to all the visible sex organs that surround the opening of the vagina outside the body. People who have a vulva can include women, trans men and people assigned female at birth.
The vulva is made up of:
- two thin, delicate folds of skin called the labia minora
- two large, hair-covered folds called the labia majora – these surround the labia minora.
Between the labia are two openings:
- the entrance of the vagina (birth canal)
- the opening of the tube that drains urine from the bladder (the urethra).
Further back, under the legs, is the opening to the back passage (anus). The area of skin between the anus and vulva is called the perineum.
Is vulval LP cancer
Vulval LP is not cancer. But it is thought that, over a long period of time, the inflammation caused by this skin condition increases the risk of cancer developing. A small number of people who have vulval LP may develop vulval cancer. This rarely happens when the condition is well controlled.
Vulval LP is more common in women in their 50s and 60s.
Symptoms of vulval LP can vary from person to person. It may cause no symptoms and be discovered during tests for other health problems, but this is rare.
The affected area of the vulva may:
- lose the top layer of skin
- become sore and itchy
- look red, raw or weepy.
This can cause a burning feeling or difficulty peeing (passing urine). It can also make having sex uncomfortable. LP can also cause a vaginal discharge, which may be bloodstained.
Over time, the skin of the vulva may scar. This can cause the opening of the vagina to narrow and make sex difficult and painful.
Many people find it embarrassing talking about symptoms like these. But it is always important to get them checked by your GP.
LP can affect other parts of the body. You may also have symptoms such as:
- itchy rash
- sore mouth.
The causes of vulval LP are not known. It is not possible to get LP through sexual contact. It is a not sexually transmitted disease and is not infectious. LP is also not caused by hormonal problems or an allergic reaction.
LP may be a type of auto-immune disease. This means the body’s immune system attacks cells in the body. Some people with vulval LP also have other auto-immune diseases such as thyroid problems or a condition called pernicious anaemia. Although these conditions can occur together, one disease does not cause the other.
Rarely, LP runs in families. It is possible it may sometimes be caused by an inherited altered gene.
If you have symptoms, you usually start by seeing your GP. If needed, they will refer you to a doctor who specialises in vulval skin conditions (dermatologist or gynaecologist).
The main tests for vulval LP are an examination of the vulva and a simple procedure to collect a skin sample (biopsy) of any abnormal looking areas. Your doctor uses a local anaesthetic to numb the area before taking a sample. You can usually have this as an outpatient. It takes about 15 minutes.
It may take 3 to 4 weeks for the results of your biopsy to be ready. Waiting for your results can be difficult. It may help to talk to a relative or close friend.
The aim of treatment for vulval LP is to control any symptoms you have. This reduces the risk of long-term problems like scarring or narrowing of the vaginal opening. It may also reduce the risk of vulval cancer developing.
Vulval LP is usually treated with a strong steroid ointment that you put on the affected area. Often a steroid called clobetasol proprionate (Dermovate®) is used.
Your doctor or specialist nurse will tell you how to use it correctly. The information leaflet with the steroid may warn against using it on the genital area. However, this treatment is safe when prescribed by your specialist doctor.
You may need to keep using the ointment to control the LP. People sometimes worry about the side effects of using a steroid on the skin. When they are used correctly, steroid ointments rarely cause any serious side effects and can control vulval LP well. Your doctor can answer any questions you have.
If the LP is very severe, sometimes you may be given:
- a steroid foam to use in the vagina
- steroid tablets
- other treatments.
Surgery is rarely used to treat LP. It may be used to improve problems such as a narrowed vaginal opening. This can help if sex has become difficult or painful. Your doctor can give you more information.
Your doctor will also give you advice about things you can do to improve your symptoms, such as:
- avoid using soap, perfumes, talc or wet wipes on the vulva
- wash with an emollient soap substitute
- wash your hair over the sink or bath to protect the vulval skin from shampoo
- avoid hot baths wear loose fitting or no underwear
- if you use a sanitary towel, use a non-perfumed type and change it regularly
- use a plain emollient on the vulval skin, such as coconut oil
- use a lubricant to protect the skin during penetrative sex.
Ask your doctor about products to avoid and which ones may be helpful. You may find you are sensitive to some creams or lubricants but that others work well for you. Some products may be available on prescription.
Vulval LP is often a long-term condition that cannot be cured. It is usually possible to control the symptoms, and this prevents further damage to the skin.
You will normally have follow-up appointments until the LP is well controlled. Your specialist will give you more information.
A very small number of people with vulval LP develop vulval cancer. This is not common but talk to your specialist doctor as soon as possible if you notice:
- a sudden change in your symptoms
- any ulcers or lumps.
Do not wait until your next appointment.
It can be difficult to know who to talk to or how to start a conversation about living with a vulval condition. But for many people, talking about it is an important way of coping.
You may find it helpful to talk to family or friends. Or you may prefer help from someone you are not close to, such as a counsellor. There is no right or wrong way to cope, but help is available if you need it. You may find the following organisations helpful:
- UK Lichen Planus – online support and information for people affected by lichen planus.
- Vulval Pain Society – information for people affected by conditions that cause vulval pain.
- The British Society for the Study of Vulval Disease – patient information and useful links to information about vulval conditions.
Below is a sample of the sources used in our vulval cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Morrison J, Baldwin P, Buckley L, et al. Gynaecological Cancer Society (BGCS) vulval cancer guidelines: recommendations for practice. 2020. Available from https://www.bgcs.org.uk/wp-content/uploads/2021/07/BGCS-vulval-guidelines-v22.pdf [accessed November 2020].
Rogers LJ, and Cuello MA. Cancer of the vulva. Int J Gynaecol Obstet, 2018; 143, S2, 4-13. Available from https://doi.org/10.1002/ijgo.12609 [accessed November 2020].
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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