Lichen Sclerosis: Symptoms, Causes & Treatment
Lichen Sclerosis (LS) is a chronic inflammatory skin condition that most commonly affects the vulva, perineum and anal region.
While it can affect people of any age and sex, it is most frequently diagnosed in post-menopausal women and women in midlife.
Lichen Sclerosis can cause significant discomfort and may affect bladder function, bowel function, sexual function and overall quality of life. Early diagnosis and appropriate treatment are important to help manage symptoms, maintain tissue health and reduce the risk of long-term complications.
The good news is that with appropriate medical management and pelvic health support, many people are able to effectively manage their symptoms and maintain a high quality of life.
What Is Lichen Sclerosis?
Lichen Sclerosis is a chronic inflammatory condition that affects the skin, most commonly around the vulva and anus. The condition may cause changes to the appearance, texture and elasticity of the skin and surrounding tissues.
Without treatment, ongoing inflammation may contribute to:
• Scarring
• Narrowing of the vaginal entrance
• Fusion of vulval tissues
• Pain with intercourse
• Difficulty with penetration
• Changes to urinary and bowel function
Because symptoms often develop gradually, many people live with the condition for years before receiving a diagnosis.
What Causes Lichen Sclerosis?
The exact cause of Lichen Sclerosis remains unknown.
Importantly, Lichen Sclerosis is:
• Not sexually transmitted
• Not contagious
• Not caused by poor hygiene
Current research suggests that autoimmune mechanisms may play a role in the development of the condition, although no single cause has been identified.
There may also be genetic, hormonal and inflammatory factors involved.
What Are the Symptoms of Lichen Sclerosis?
Symptoms vary between individuals and may fluctuate over time.
Many people experience periods where symptoms improve, followed by flare-ups.
Common symptoms include:
• Persistent itching of the vulva or anal area
• Burning or irritation
• White, pale or shiny patches of skin
• Thin, fragile skin that tears easily
• Thickened or crinkled skin
• Pain during intercourse
• Pain with tampon use
• Pain with pelvic examinations
• Narrowing of the vaginal entrance
• Cracking or splitting of the skin
• Bleeding after friction or penetration
• Changes in the appearance of the vulva
• Fusion or shrinking of the labia
• Changes around the clitoral hood
In some cases, urinary or bowel symptoms may also occur if surrounding tissues become irritated or scarred.
Why Can Lichen Sclerosis Cause Pain With Sex?
Painful intercourse is one of the most common challenges experienced by people living with Lichen Sclerosis.
Several factors may contribute:
Tissue Fragility
The skin may become thinner, more sensitive and more prone to splitting or irritation.
Vaginal Entrance Narrowing
Inflammation and scarring may contribute to narrowing of the vaginal opening, making penetration uncomfortable or difficult.
Pelvic Floor Muscle Tension
When penetration becomes painful, the pelvic floor muscles often respond by tightening protectively.
Over time, this protective muscle guarding can become persistent and contribute to:
• Pain with penetration
• Burning sensations
• Vaginismus
• Pelvic floor tightness
• Fear of penetration
This is one reason why many people with Lichen Sclerosis benefit from a combination of medical treatment and pelvic floor therapy.
What Is the Best Treatment for Lichen Sclerosis?
Management is typically multidisciplinary and should be guided by an experienced healthcare professional.
Treatment may involve a combination of medical, lifestyle and pelvic health approaches.
Topical Corticosteroids
Prescription corticosteroid ointments remain the gold standard first-line treatment for Lichen Sclerosis.
These medications help:
• Reduce inflammation
• Control symptoms
• Prevent progression
• Reduce scarring risk
Treatment should always be guided by your doctor or specialist.
Moisturisers and Barrier Care
Regular use of appropriate moisturisers may help support tissue comfort and reduce irritation.
Lifestyle Modifications
Helpful strategies may include:
• Wearing loose-fitting clothing
• Avoiding harsh soaps and cleansers
• Using gentle skincare products
• Reducing friction where possible
Regular Medical Follow-Up
Regular review is important to:
• Monitor symptoms
• Assess treatment response
• Identify any progression or complications
Can Pelvic Floor Physiotherapy Help Lichen Sclerosis?
Yes.
While pelvic floor physiotherapy does not directly treat the skin condition itself, it can be extremely valuable in managing the secondary effects that often develop.
Many individuals with Lichen Sclerosis develop:
• Pelvic floor muscle tension
• Painful intercourse
• Vaginismus
• Fear of penetration
• Bladder urgency
• Constipation or bowel dysfunction
A pelvic floor physiotherapist may assist with:
Pelvic Floor Relaxation
Learning how to relax overactive pelvic floor muscles may help reduce pain and improve comfort.
Pain Management Strategies
Treatment may include education, breathing strategies, nervous system regulation and movement-based approaches.
Bladder and Bowel Support
If symptoms have begun affecting bladder or bowel function, treatment may address these areas as well.
Education and Confidence Building
Understanding what is happening in your body can reduce fear and improve confidence with intimacy and daily activities.
How Can Vaginal Dilators Help Lichen Sclerosis?
For some individuals, vaginal dilators may form part of a comprehensive treatment plan.
Dilators are smooth, graduated devices designed to help the body become more comfortable with penetration over time.
Under professional guidance, they may assist with:
• Maintaining vaginal flexibility
• Reducing fear-based guarding
• Improving tolerance to penetration
• Supporting comfort during intercourse
• Gradually addressing vaginal entrance narrowing
Dilators should never be forced and should always be introduced gradually and comfortably.
Explore BIEN Vaginal Dilators:
https://bien.com.au/collections/vaginal-dilators
Can Pelvic Floor Wands Help?
If pelvic floor tension or trigger points have developed alongside Lichen Sclerosis, a pelvic floor wand may be recommended by your pelvic health professional.
In appropriate cases, wands may assist with:
• Pelvic floor muscle release
• Trigger point management
• Improving muscle awareness
• Supporting relaxation strategies
Explore BIEN Pelvic Floor Wands:
https://bien.com.au/collections/pelvic-floor-wands
When Should You Seek Help?
Seek assessment if you experience:
• Persistent vulval itching
• Pain with penetration
• Vaginal splitting or tearing
• Changes in the appearance of the vulva
• Difficulty using tampons
• Burning or irritation that does not improve
• Bladder or bowel symptoms associated with vulval discomfort
Early diagnosis and treatment can significantly improve long-term outcomes.
With the right support, many people living with Lichen Sclerosis are able to successfully manage their symptoms and maintain an active, comfortable and fulfilling quality of life.
