How Does Lichen Sclerosus Affect Sexual Health in Women?

Lichen sclerosus (LS) is a lifelong, noncontagious skin condition that affects about 0.1% to 3% of people. LS more often affects women, with postmenopausal women and prepubescent girls at higher risk. While it can occur in different places on the body, LS occurs most often in the genital and anal areas.

LS may look like white, smooth, or shiny spots on the skin that can be very itchy.  In women, one common pattern for LS is a “figure-eight” appearing around the vulva and anus. Over time, affected areas and small skin tears caused by LS can create scar tissue. This scar tissue can cause physical changes to the vulva, including:

• Clitoral phimosis: the clitoral hood is fused, sometimes trapping the clitoris underneath
• Narrowing of the vaginal opening
• Fusion of the labia minora (inner) and majora (outer), or the labia minora is reabsorbed into the labia majora

LS can be difficult to recognize because it is underrecognized and does not always cause symptoms. This also means there are fewer cases available for research. LS may also look like some sexually transmitted infections (STIs) or yeast infections. This can delay the right diagnosis and treatment, which may increase the risk of physical changes.

These changes can affect a woman's quality of life, including her sexual health. Sexual dysfunction may be caused by physical changes, inflammation, skin tears, or scarring from LS.

Sexual Dysfunction and LS

Dyspareunia, or pain during sexual activity, is likely the most common sexual dysfunction to affect women with LS. This can be caused by inflammation, skin tears, and the narrowing of the vaginal opening.

Women with LS may also experience fewer orgasms during sexual activity. This may be due to dyspareunia or physical changes, such as clitoral phimosis or a buried clitoris. A partner's response to LS symptoms may also play a role.

LS can affect how a woman feels about her vulva, body, and sexual activity. These feelings may affect her sexual response and ability to orgasm. Shame, low body image, negative partner reactions, and dyspareunia may also lead to less sexual activity.

Managing LS and Its Symptoms

There is not enough research to confirm whether LS is an autoimmune disease. However, LS shares some features with autoimmune diseases and can occur in people with other autoimmune conditions. Treatment for LS typically revolves around long-term. 

LS is also associated with a small risk for vulvar cancer, around 2%-5%. Potent topical steroid creams are the first recommended approach. These can help reduce inflammation and calm the immune system to keep cells from attacking healthy tissue. Certain lifestyle changes can also be made to avoid further irritation and inflammation.

Light therapy may also help with inflammation. In some cases, immunosuppressants may be prescribed to calm the immune system. Surgery may be recommended if LS is causing a reduced quality of life. Surgery can help repair key structures, such as the clitoral hood, vaginal entrance, and labia. 

Key Takeaways

• LS is a chronic skin condition that can cause skin tearing and scarring in the vulvovaginal area.
  • This scarring can cause physical changes to the vulva.
• LS can cause sexual dysfunction, such as dyspareunia, fewer orgasms, and fewer sexual encounters.
  • Sexual dysfunction can be from physical changes, a partner’s response to the condition, or feelings of shame, low body image, and low self-esteem.
• Treatment includes pharmacological options like steroids and immunosuppressants, light therapy, and surgery. Lifestyle changes may also be helpful.
• LS is not contagious and may be more similar to an autoimmune disease.
• Because LS is a lifelong condition, regular follow-up with a healthcare professional is recommended even when symptoms are under control.
• If your vulva presents with small, white, shiny spots and feels itchy or inflamed, it may be helpful to speak with a healthcare professional for an evaluation.

Resources

Chamli, A., & Souissi, A. (2023). Lichen sclerosus (PMID: 30855834). National Library of Medicine, National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK538246/

Pope, R., Lee, M. H., Myers, A., Song, J., Abou Ghayda, R., Kim, J. Y., Hong, S. H., Lee, S. B., Koyanagi, A., Jacob, L., Smith, L., & Shin, J. I. (2022). Lichen sclerosus and sexual dysfunction: A systematic review and meta-analysis. The Journal of Sexual Medicine, 19(11), 1616–1624. https://doi.org/10.1016/j.jsxm.2022.07.011

Smith, A. B., Muhammad, N. I., Cigna, S. T., & Krapf, J. M. (2023). A systematic review of sexual health consequences among women with lichen sclerosus. Sexual Medicine Reviews, 11(1), 8–14. https://doi.org/10.1093/sxmrev/qeac002

 [JY1]Goal is disease control to prevent scarring and cancer, even when asymptomatic; usually long-term maintenance.

 [JY2]Urethral stricture is male LS. In women: clitoral phimosis release, introital/perineal surgery.

 [JY3]Missing: small vulvar cancer risk (~2–5%), lowered by consistent treatment; needs lifelong follow-up.