Genital lichen sclerosus: what it is, what consequences it causes and how to treat it

By Cristiano Antonino On Nov 4, 2022

Itching, pain and burning, all localised to the intimate parts: in most cases, genital lichen sclerosus manifests itself in this way

However, the symptoms may vary with age and sometimes may even be absent.

It was once thought to be a disease mainly related to menopause, but today we know that it can affect all ages: it is even estimated that about 7% of cases affect girls and children.

Diagnosis of lichen can be complex, particularly in its early stages: here the signs and symptoms may overlap with those of other genital disorders, including infections and other dermatoses, and may therefore ‘escape’ an untrained eye.

In some cases of paediatric genital lichen, the clinical manifestations may even be mistaken for signs of sexual abuse.

This is why it is so important to be thoroughly familiar with this pathology.

What is vulvar sclerosing lichen?

It is a little-known but not so rare condition that affects at least 2 out of every 100 women (2 to 7% of the female population).

It is a disease characterised by an alteration in the trophism of the vulvar skin and mucous membranes, leading to thinning and loss of elasticity.

The causes are also poorly understood: an autoimmune origin has been hypothesised, and in recent studies a certain familiarity has also emerged: in some families, in practice, this disease may be more frequent than in others.

It is a disease that can occur at any age: from little girls, to girls, to adult women, or at menopause.

In the youngest, the typical age at which it develops is between 4 and 6 years.

It is important not to underestimate it: if neglected, it can lead to significant changes in vulvar anatomy or the risk of developing pre-neoplastic or neoplastic lesions of the vulva.

Lichen sclerosus, what are the signs and symptoms in adult women?

In adult women, vulvar lichen sclerosus may be the cause of pain during and after sexual intercourse.

According to recent studies, pain during intercourse and the appearance of small vulvar fissures (a kind of small ‘cuts’) following sexual activity are the most frequent symptoms in the early stages of the disease in women of childbearing age.

In contrast, the most typical symptom of full-blown disease is vulvar itching, often accompanied by burning, caused by abrasions from constant scratching. Patients may also experience burning on urination and notice minimal bleeding at the fissures and muco-cutaneous abrasions.

Signs of the disease include the presence of whitish areas, small cuts and/or reddened areas in the vulvar skin and mucosa, and in more advanced cases, more or less obvious changes in the vulvar anatomy.

What are the signs and symptoms in girls?

Younger patients have more nuanced symptoms than adult women, partly because they often have difficulty explaining their discomfort in words.

Thus, in addition to vulvar itching and burning, little girls may present with bleeding, constipation if the perianal skin is also affected, irritability, sleep disturbances and a consequent drop in school performance.

In paediatric age, however, changes in the vulvar anatomy are rarer and less evident.

Can vulvar lichen sclerosus be cured?

As with the symptoms, a distinction must be made between adult women and children.

Vulvar lichen sclerosus of adulthood is considered a chronic, lifelong disease, although its symptoms can be controlled by appropriate therapy; on the other hand, the scientific literature is not in agreement regarding the chronicity of paediatric vulvar lichen sclerosus.

In one of our scientific studies we observed that in more than half of the girls the disease persists into adulthood.

In less than 20% of the cases the disease resolves after puberty, while in the remaining cases vulvar sclerosing lichen seems to remain in a long dormant phase, in which symptoms are no longer present but changes in the vulvar anatomy remain.

For this reason it is recommended to undergo periodic check-ups throughout life, even in cases where the disease appears to be silent.

Vulvar lichen sclerosus has in fact an intermittent course, and may recur even after long dormant phases.

Performing periodic check-ups is also important to diagnose the presence of any pre-tumour or cancerous lesions or changes in the anatomy of the vulva.

Can vulvar lichen sclerosus then develop into a tumour?

In 5% of cases, without proper treatment, lichen can evolve over time into a malignant vulvar tumour.

To avoid this, it is essential to be followed by a team of specialists who know the disease well.

Indeed, in patients who receive the appropriate treatment and are followed regularly, the risk of cancer is significantly reduced.

Are there specific courses for younger patients?

The course of treatment is no different from that followed by adult patients: it starts with a gynaecological examination that is neither painful nor invasive, where the vulva is thoroughly examined with the aid of an instrument that helps us zoom in on the details.

The aim is both to make the diagnosis and to set the most correct therapy for the individual case.

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