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, see your GP. They will examine you and may need to do further tests.

LS and LP can be treated but cannot 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 cannot be passed on through sex. If you are feeling embarrassed or worried about having LS or LP, there is help and support available.

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

Lichen sclerosus and lichen planus are non-cancerous skin conditions that commonly affect the vulva. When they affect the skin of the vulva, they are known as vulval LS or LP.

LS is more common in:

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

LP usually occurs in women in their 50s and 60s.


What is the vulva?

The vulva is the name given to all the visible sex organs of a woman (see diagram below). It is made up of:

  • two thin, delicate folds of skin called the labia minora
  • two large, hair-covered folds called the labia majora, which 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).

At the front of the vulva, above the vagina and urethra, is the clitoris. This small organ is very sensitive and helps a woman reach sexual climax (orgasm).

On either side of the vagina are two small glands called Bartholin’s glands. These make a fluid that acts as a lubricant during sex.

Above the vulva is an area of fatty tissue called the mons pubis.

Further back, under the legs, is the opening to the back passage (anus). It is separated from the vulva by an area of skin called the perineum.

The vulva
The vulva

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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 is possible they may sometimes be caused by an inherited altered gene.

About 4 in 10 women (40%) with LS and LP also have an autoimmune 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 or LP through sexual contact. They are not sexually transmitted diseases and are not infectious. They are also not caused by hormonal problems or any allergic reaction.


Signs and symptoms 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 is possible they may sometimes be caused by an inherited altered gene.

About 4 in 10 women (40%) with LS and LP also have an autoimmune 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 or LP through sexual contact. They are not sexually transmitted diseases and are not infectious. They are also not caused by hormonal problems or any allergic reaction.

Signs and symptoms of LS and LP

The symptoms vary from woman to woman. Rarely, some women have no symptoms and the LS or LP 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).

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

In vulval LP, the affected area may:

  • lose the top layer of skin and become sore
  • look red and raw.

This can cause difficulty passing urine and having sex. LP can affect the vagina and may cause a vaginal discharge, which may be bloodstained.

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 or LP. If you have any of them, let your GP know.


Diagnosing LS and LP

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

The signs and symptoms of LS and LP can vary. 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 LS and LP

LS and LP are 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 or LP 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 is rarely used to treat LS or LP. 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 LS and LP

For most women, LS and LP are long-term conditions 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 or LP is well controlled. Your specialist will give you more information.

About 3 or 4 out of every 100 women (3 to 4%) who have vulval LS or an uncommon thickened type of LP develop vulval cancer. It is thought that over a long period of time, the inflammation caused by these skin conditions increases the risk of cancer developing. It is very rare in women whose symptoms are well controlled.

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

You may have many different emotions, including anger and resentment, guilt, anxiety and fear. These are all normal reactions. They are part of the process many people go through when coming to terms with their condition.

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.

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