What is vulval lichen sclerosus (LS)?

Lichen sclerosus (LS) is a skin condition that commonly affects the vulva. When it affects the skin of the vulva, it is known as vulval lichen sclerosus.

Vulval LS is more common in:

  • young girls, usually between 3 and 5 (prepubertal)
  • women going through the menopause (perimenopausal)
  • women after the menopause (postmenopausal).

Vulval LS is not cancer. But a small number of women who have vulval LS may develop vulval cancer. It is very rare in women whose symptoms are well controlled. It is thought that, over a long period of time, the inflammation caused by this skin condition increases the risk of cancer developing.

Other vulval skin conditions

There are other conditions that can affect the skin of the vulva. We have more information about vulval lichen planus (LP) and vulval intraepithelial neoplasia (VIN).

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Symptoms of vulval LS

The symptoms of vulval LS vary from woman to woman. Rarely, some women have no symptoms and the LS may be discovered during tests for other health problems.

In vulval LS, the skin in the affected area may:

  • be itchy and sore, which may be worse at night
  • change colour, becoming pale or white
  • develop small areas of bruising that look like blood blisters
  • be more fragile than normal skin and possibly split. This is common in children and can cause difficulty opening the bowels (constipation).

Vulval LS does not affect the vagina and does not cause a discharge.

Over time, the skin of the vulva may scar and shrink. This can cause the opening of the vagina to narrow, making sex more uncomfortable.

These symptoms can be caused by conditions other than LS. If you have any of them, let your GP know.

Causes of vulval LS

The causes of vulval LS are unknown.

Some women have other family members with LS, so it is possible it may sometimes be caused by an inherited altered gene.

Some women with vulval LS also have an illness, such as thyroid problems or pernicious anaemia. Although these conditions can occur together, one disease does not cause the other.

It is not possible to get LS through sexual contact. It is not a sexually transmitted disease and is not infectious. LS is also not caused by hormonal problems or any allergic reaction.

Diagnosing vulval LS

Your GP will examine you and, if needed, refer you to a doctor who specialises in vulval conditions (gynaecologist) or a skin specialist (dermatologist).

You may need to have a small sample of cells taken from the affected area to be looked at under a microscope (a biopsy). This is usually done in the outpatients department.

Before a biopsy is taken, a local anaesthetic cream is used to numb the area. This usually takes around 10 minutes to work. A local anaesthetic is injected into the area using a small needle. A small sample of skin is then removed. Very rarely, a general anaesthetic may be necessary if several samples are needed.

Treating vulval LS

Steroid creams

Vulval LS is usually treated with a strong steroid ointment that is applied to the affected area (topical treatment). Often a steroid called clobetasol proprionate (Dermovate®) is used. Your doctor, specialist nurse or the pharmacist will tell you how to use the ointment.

Topical steroid treatment can often control the symptoms very well, but you may need to use the ointment from time to time. Treating the inflammation with the steroid ointment may also make sex easier, as the skin is less likely to split if it is not inflamed.

The information leaflet with the steroid ointment may warn against using it on the genital area. However, this treatment is safe when prescribed by a specialist.

Sometimes, if the LS is very severe, you may be treated with a steroid foam that is put into the vagina. You may also be given steroid tablets for a short time.

Your doctor will also advise you to use a non-perfumed moisturiser instead of soap on the vulval area and to wear comfortable, loose-fitting clothes.

Surgery

Surgery is rarely used to treat LS. It is only used to relieve problems caused by scarring, such as a narrowed vaginal opening. This can help if sex has become difficult or painful. Your doctor can give you more information.

Follow-up for vulval LS

For most women, vulval LS is a long-term condition that cannot be completely cured. But it is usually possible to control the symptoms, and you should not have any further shrinkage or scarring of the area.

You will normally have follow-up appointments until the LS is well controlled. Your specialist will give you more information.

Some women who have vulval LS develop vulval cancer. This is not common but if you notice a sudden change in your symptoms or any ulcers or lumps, talk to your specialist doctor as soon as possible. Do not wait until your next appointment.

Your feelings

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends. Others prefer to seek help from people outside of their situation, such as a counsellor. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. Our cancer support specialists can give you support and information about counselling in your area.