Lichen Sclerosus us is the hidden condition every woman should know about. If you’ve found yourself here, I want to say right away: you are not alone. Far too many women are quietly struggling with symptoms that have either been misdiagnosed or, worse still, dismissed altogether. Vulval lichen sclerosus is one of those conditions that deserves far more recognition and understanding than it currently receives — especially among women who are going through the menopause or perimenopause.
I’ve lost count of the number of times I’ve seen women in my clinic who’ve been told their symptoms are “just part of getting older” or “probably just due to low oestrogen.” And while oestrogen deficiency certainly plays a role, vulval lichen sclerosus is a separate, serious condition that requires its own dedicated treatment plan. Let’s dive deep into what this is, why it’s so commonly missed, and most importantly, what you can do about it.
What Is Vulval Lichen Sclerosus?
Vulval lichen sclerosus is a chronic inflammatory skin condition that affects the vulva — the external part of the female genitals. It’s classed as an autoimmune disorder, meaning your immune system mistakenly attacks your own healthy skin tissue.
Over time, this causes thinning of the vulval skin, making it more fragile, prone to tearing, and intensely uncomfortable. What many people don’t realise is that it doesn’t just affect postmenopausal women (although it is most common in this group). It can occur at any age, even in young girls.
The exact cause is still being unravelled, but we know that hormonal changes, particularly the drop in oestrogen levels during menopause, can worsen the condition — hence the confusion with simple menopausal symptoms.
Symptoms: It’s Not Just ‘Dryness’
Here’s the trouble: many of the early symptoms of vulval lichen sclerosus can mimic those of vulval atrophy (thinning of the tissues due to low oestrogen). So, it’s not surprising that women — and even Doctors —regularly miss it.
You might experience:
- Persistent itching (often described as unbearable or relentless)
- Soreness, burning, or pain in the vulval area
- Cracks or splits in the skin
- White, patchy areas on the vulva that look like “parchment”
- Pain during intercourse (dyspareunia)
- Bleeding after sex or after using the loo
- Shrinking or distortion of the vulval anatomy over time
- Fusion of the labia (where the skin begins to stick together)
Some women have no symptoms at all until the condition has progressed significantly, which is why regular examination and a high index of suspicion are crucial.
Why Vulval Lichen Sclerosus Is So Commonly Misdiagnosed
One of the biggest challenges with vulval lichen sclerosus is that it’s frequently mistaken for other conditions, especially in women going through hormonal transitions.
If you’re in menopause or perimenopause, your falling oestrogen levels thin the vaginal and vulval tissues — causing dryness, irritation, and pain during sex. Understandably, many women and clinicians initially assume this is the whole story.
But vulval lichen sclerosus is different. And without the right diagnosis, women are left suffering needlessly, and tragically, there is an increased risk of developing vulval cancer if the condition goes untreated.
What makes matters worse is that some women feel embarrassed to talk about intimate symptoms, or they’ve been made to feel like they’re making a fuss over nothing. Let me assure you: if you’re experiencing any of the symptoms I’ve described, please don’t suffer in silence.
How We Diagnose Vulval Lichen Sclerosus
Diagnosing vulval lichen sclerosus starts with a thorough history and clinical examination. As a private GP and menopause expert, I always take the time to really listen.
Examination of the vulval area is essential. If we see characteristic pale, white patches, it may be lichen sclerosus.
It’s vital that diagnosis isn’t delayed — early identification means earlier treatment and a far better outcome.
Vulval Lichen Sclerosus Treatment: What Works Best
The mainstay of vulval lichen sclerosus treatment is high-potency topical steroids. Yes, steroids might sound a little alarming, but they are incredibly effective in halting disease progression and reducing symptoms.
Typically, we use a medication like clobetasol propionate ointment, applied daily at first, and then gradually reducing frequency as the condition comes under control.
In addition to steroids, there are other helpful steps:
- Emollients: Regular use of soothing moisturisers can help protect the skin barrier and reduce friction.
- Avoid irritants: Ditch the perfumed soaps, bubble baths, and scented wipes. Stick to gentle, non-soap cleansers or just water.
- Sexual wellbeing: Painful sex isn’t something you have to “just put up with.” Vaginal moisturisers and lubricants can make intimacy more comfortable, and where appropriate, vaginal oestrogen can be used alongside lichen sclerosus treatment.
- Close follow-up: I always encourage my patients to have regular reviews to monitor their progress and adjust treatment if needed.
If you’re looking for vulval lichen sclerosus treatment, it’s crucial to work with a clinician experienced in the condition. I keep up to date with the latest vulval lichen sclerosus guidelines, and we work together to build a treatment plan that’s tailored to you.
How Soon After Starting Treatment Will I Feel Better?
Most women begin to notice improvements within the first few weeks of consistent treatment. The relentless itching often settles first, followed by gradual improvement in skin texture and comfort.
However, it’s important to complete the full treatment course and maintain ongoing maintenance therapy. Vulval lichen sclerosus isn’t something you “cure” — it’s about long-term management and keeping your skin healthy for life.
Other Treatments for Vulval Lichen Sclerosus
Whilst steroids are the gold standard, some women with particularly stubborn or severe lichen sclerosus benefit from advanced therapies.
As a private GP, I work closely with specialist dermatologists to explore treatments like:
- Phototherapy (UV light therapy): Helpful for severe or extensive cases.
- Topical immunomodulators: Creams such as tacrolimus or pimecrolimus help calm the immune system in resistant cases.
- Oral immunosuppressants: Rarely, if the condition is unresponsive, tablets that dampen the immune system may be prescribed.
- Surgery: In advanced cases where there’s significant scarring, surgery can help restore comfort and improve function.
What’s vital is that your care is fully personalised. We don’t take a “one size fits all” approach here.
Vulval Lichen Sclerosus and Lichen Planus: Are They Connected?
Yes — vulval lichen sclerosus and lichen planus are distinct, but they can co-exist. Both are autoimmune conditions that affect the vulva, and both can cause soreness, scarring, and structural changes.
Lichen planus often involves not just the vulva but also the vagina, inside the mouth, or other mucosal areas. It can cause erosions and painful raw patches.
When both conditions are present, treatment needs to be even more carefully tailored, and specialist input from dermatology or gynaecology may be helpful. I always ensure a multidisciplinary approach when needed, so you get the very best care.
Is Vulval Lichen Sclerosus Cancerous?
Vulval lichen sclerosus itself is not cancer — but it is a recognised risk factor for vulval cancer, specifically vulval squamous cell carcinoma.
If lichen sclerosus is left untreated, or inadequately managed, the ongoing inflammation and skin damage can lead to precancerous changes. Statistics suggest that around 4–5% of women with vulval lichen sclerosus will go on to develop vulval cancer if the condition is not properly controlled.
This is why regular follow-up is so critically important. Early detection of changes makes all the difference in treatment outcomes. During your reviews, I will examine your skin carefully, looking for any areas of thickening, ulceration, or unusual changes that could signal early cancerous development.
Your follow-up appointments are your safety net. They allow us to catch anything early, when treatment is most effective and outcomes are far better. Vulval cancer, when detected early, is very treatable — and I want that reassurance to be front and centre for you.
Is Vulval Lichen Sclerosus Contagious or an STI?
No — and let me emphasise this, because it’s an important (and often misunderstood) point: vulval lichen sclerosus is not contagious. It’s not an infection, and it’s not something you can pass to a partner during sex or physical contact.
It is an autoimmune condition, which means it’s caused by your immune system mistakenly attacking your own skin tissue. You have absolutely nothing to feel embarrassed or ashamed about.
Can I Have Sex If I Have Vulval Lichen Sclerosus?
Yes, but it may require time, patience, and the right treatments to make it comfortable.
Pain during sex is one of the most distressing symptoms I see in my patients, but with good treatment — including steroid ointments, vaginal moisturisers, lubricants, and even vaginal oestrogen if appropriate — intimacy becomes much more manageable.
And remember, it’s not just about physical comfort. Emotional support and communication with your partner are equally important. If you’re struggling, we can work together to find the right solutions for you.
What Happens If You Don’t Get the Right Diagnosis?
This is where things can take an unfortunate turn. Without the correct diagnosis and treatment, lichen sclerosus can quietly progress, leading to:
- Permanent scarring of the vulval tissues
- Fusion of the labia
- Difficulty passing urine
- Painful sexual function
- Increased risk of vulval cancer
The bottom line is this: early diagnosis and treatment protect both your comfort and your long-term health. This is why regular examinations and speaking up about symptoms is so important.
Don’t Assume It’s “Just” the Menopause
This is my plea to every woman reading this. Please, don’t assume that vulval discomfort is “just part of the menopause.”
Yes, low oestrogen plays a role in vulval dryness, but vulval lichen sclerosus is a separate and serious condition. Vaginal oestrogen alone will not treat it.
When you book a menopause appointment at Essex Private Doctors, I will always perform a full, careful assessment of your vulval health — not just your hormones. If you’re already on HRT but still experiencing symptoms, this is especially important.
Getting the right diagnosis early can spare you years of discomfort and worry.
In Summary: You Are Not Alone, and Help Is Here
Vulval lichen sclerosus is a hidden but incredibly important condition. It’s not just “part of ageing.” It’s not something to be embarrassed about. And it’s certainly not something you have to put up with.
Early diagnosis and the right treatment can transform your quality of life. Whether you’re experiencing itching, discomfort, painful sex, or you’re simply not sure — don’t wait.
