Vulval lichen sclerosus and lichen planus

Vulval lichen sclerosus (LS) and lichen planus (LP) are conditions that affect the skin of the vulva. The vulva is the external outer area of a woman’s genitals.

For a small number of women, LS or LP can develop into a type of skin cancer called squamous cell cancer. This can take many years.

Symptoms of LS and LP can include itchy, sore or fragile skin around the vulva, which may have changed in colour. Having sex and passing urine may be uncomfortable. Not everyone has symptoms but if you notice any of these signs, go and see your GP. They will examine you and may need to do further tests.

LS and LP can be treated but can't be completely cured. Your doctor will usually prescribe treatment with a steroid ointment. The doctor will explain how often you use this. It can often control the symptoms very well.

LS and LP are not infectious and can’t be passed on through sex. If you’re feeling embarrassed or worried about having LS or LP, there’s help and support available if you need it.

What is the vulva?

The vulva is a woman's external genital area. It includes two large, hair-covered folds of skin called the labia majora, which surround two thin and delicate folds called the labia minora. The labia majora and labia minora surround the opening of the vagina and the tube urine is passed through (the urethra).

The clitoris is above the vagina and urethra. This small structure is very sensitive and helps a woman reach sexual climax (orgasm). The opening to the back passage (anus) is separated from the vulva by an area of skin called the perineum.

The vulva
The vulva

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What are vulval lichen sclerosus (LS) and lichen planus (LP)?

Lichen sclerosus and lichen planus are fairly common, non cancerous skin conditions. They can affect different parts of the body, but commonly affect the vulva. When they affect the skin of the vulva, they’re known as vulval LS or LP.

LS and LP can affect children and adults. These conditions can be controlled by treatment but can't be cured.

LS and LP are not cancer. But in a few people, over many years, they may develop into a type of skin cancer known as squamous cell cancer. Only around 3–5 out of every 100 women with lichen sclerosus or lichen planus will develop cancer.

Causes of LS and LP

The causes of LS and LP are unknown. Some women with these conditions have other family members with LS or LP, so it's thought they may sometimes be caused by an inherited altered gene. LS and LP are more common in older women and women who have autoimmune illnesses, such as thyroid problems or pernicious anaemia.

It's not possible to get LS or LP through sexual intercourse. They aren't sexually transmitted diseases and they're not infectious.

Symptoms of LS and LP

The skin in the affected area becomes very itchy and sore, with a change in colour. The skin becomes more fragile than normal skin and may split, causing stinging and pain. Occasionally, this leads to difficulties with passing urine or having sex. The vagina may become narrowed, and sex may become uncomfortable.

The symptoms vary from woman to woman, and some women with LS or LP have no symptoms at all. In this case, the condition may be discovered during medical examinations for other health problems.

These symptoms can be caused by conditions other than LS or LP. If you have any of them, let your GP know. They can examine you and refer you to a doctor who specialises in women's health (a gynaecologist).

Diagnosis of LS and LP

The symptoms of LS and LP can vary and are similar to other conditions of the vulva. For these reasons, you may need to have a small sample of cells taken from the affected area to be examined under a microscope (a biopsy). This is done in the outpatients department. An anaesthetic cream is usually used to numb the area first. This takes around 20 minutes to work. Local anaesthetic is then injected into the area using a small needle. Sometimes, a general anaesthetic is used. A sample of cells about 3mm wide (an eighth of an inch) is taken from the vulva.

Treatment for LS and LP

Your doctor will usually prescribe a steroid ointment called clobetasol proprionate (Dermovate®). You usually use this once a day for one month, alternate days for one month, then twice weekly for a month. Then you will see your doctors again. This treatment is safe and can often control the symptoms very well, but you may need to use it from time to time. Treating the inflammation with the topical steroid ointment may also make sex easier as the skin is less likely to split if it is not inflamed.

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

Surgery is rarely used to treat LS or LP. Sometimes, it’s used to relieve problems caused by scarring, such as a narrowed vaginal opening. This can help if sex has become difficult or painful.

Follow-up for LS and LP

As LS and LP are long-term conditions that can't be completely cured, you may continue to have symptoms. Your specialist will let you know if any follow-up is needed after treatment. This may be at the hospital or at your GP surgery.

Women who’ve had LS or LP for many years have a small risk of developing a vulval cancer. This usually occurs in women in their 60s–90s, rather than in younger women. It's important to see your doctor or nurse regularly to check for any signs of a cancer developing. This is so that if cancer does develop, treatment can be given at an early stage, when there's a high chance of it being cured.

Tell your doctor if you develop any symptoms you are concerned about, such as a lump or swelling, or any itching, bleeding or burning pain.

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