Screening & Gynecologic Cancer
Lichen Sclerosus: Symptoms, Treatment and Vulvar Cancer Risk
Lichen sclerosus is a long-term inflammatory skin condition that most often affects the vulva and the skin around the anus. It causes intense itching, soreness and thin, white, crinkly patches of skin. It isn't an infection and isn't contagious. Prescription steroid ointment usually controls it well, and because it carries a small increased risk of vulvar cancer, it needs ongoing follow-up.
A very common path to diagnosis goes like this: months, sometimes years, of what seems like a yeast infection that never quite clears. Cream after cream from the drugstore. Then a clinician finally looks closely and sees the white patches. If that sounds familiar, this article is for you.
What it feels like
The main symptom is itching, often severe and worse at night. Many people say it wakes them up, or that they scratch in their sleep. Other signs:
- White, shiny or wrinkled patches on the vulva or around the anus, often in a figure-8 pattern
- Thin, fragile skin that tears, bruises or bleeds easily
- Soreness or burning
- Pain during sex
- Painful bowel movements or constipation, especially in children
- Small cracks (fissures) in the skin
Some people have no symptoms at all and find out during a routine exam.
Who gets it
It can happen at any age, but it's most common in:
- People after menopause
- Girls before puberty
It can also affect men and people of any gender. The exact cause isn't known; it's thought to involve the immune system. People with lichen sclerosus are more likely to have other autoimmune conditions, like thyroid disease or vitiligo, and genetics may play a part.
Two things it is not: caused by poor hygiene, or sexually transmitted. People ask both, often quietly. The answer is no.
Is it this, or something else?
| Condition | Typical features |
|---|---|
| Lichen sclerosus | White, thin, wrinkled patches; scarring over time; often after menopause |
| Yeast infection | Thick white discharge, redness, burning; responds to antifungals |
| Lichen simplex chronicus | Thick, leathery skin from long-term scratching |
| Lichen planus | Raw red areas, may involve the vagina and mouth |
| Contact dermatitis | Reaction to soaps, pads, wipes or products |
| Genitourinary syndrome of menopause | Dryness, burning and thinning from low estrogen |
| VIN or vulvar cancer | Lump, sore, thickened or discolored area that doesn't heal |
If an over-the-counter yeast treatment hasn't worked, stop buying more and get examined. Repeated self-treatment is the main reason this diagnosis gets delayed.
The diagnosis: what the visit and biopsy are like
A gynecologist or dermatologist can often recognize lichen sclerosus just by looking. A small skin biopsy is often done to confirm it, and it's especially important if:
- The diagnosis is unclear
- An area looks thickened, raised or ulcerated
- The skin doesn't improve with treatment
The biopsy happens in the office and takes a few minutes. You'll get a numbing injection first, which stings for a few seconds; after that most people feel pressure, not pain. The spot is tiny, may get a stitch or two, and is usually sore for a few days. Results often take a week or two.
Treatment
Prescription steroid ointment
The standard treatment is a strong (high-potency) topical corticosteroid ointment, prescribed by your clinician. You'll usually use it more often at first, then taper to a maintenance schedule. Follow your clinician's exact instructions on how much and how often.
The most common worry: "Isn't a strong steroid going to damage delicate skin?" When it's used as directed for lichen sclerosus, it's considered safe and effective. In fact, long-term maintenance helps prevent flares, scarring and possibly cancer. Many patients notice the itching easing within a few weeks.
Tip: Ask your clinician to show you exactly where to apply it, using a hand mirror. Many people put it in the wrong spot at first.
Other options
- Other prescription creams if steroids aren't tolerated
- Vaginal estrogen if menopause-related dryness is also part of the picture
- Surgery to release scar tissue in severe cases
- Pelvic floor physical therapy or dilators for painful sex
Daily care
- Use a plain, unscented emollient or petroleum jelly as a barrier
- Skip soap, bubble bath, wipes and scented products on the vulva
- Wear loose cotton underwear
- Pat dry instead of rubbing
- Use lubricant during sex
What happens without treatment
Over time, untreated lichen sclerosus can cause scarring, which may lead to:
- Shrinking or loss of the inner labia
- The clitoral hood fusing over the clitoris
- Narrowing of the vaginal opening, making sex painful or impossible
Early treatment can prevent or limit these changes. That's the strongest argument for not waiting.
The cancer question
People with vulvar lichen sclerosus have a small increased risk of vulvar squamous cell carcinoma. Most people with lichen sclerosus never develop cancer, and studies suggest that consistent long-term treatment lowers the risk.
Get these checked promptly:
- A lump, bump or thickened area
- A sore or ulcer that doesn't heal
- A new area of color change
- Bleeding not related to scratching or sex
- Pain or itching that suddenly gets worse despite treatment
A biopsy can check for vulvar intraepithelial neoplasia (VIN), a precancer, or cancer. If cancer is found, care is usually led by a gynecologic oncologist. See when to see a gynecologic oncologist.
Your follow-up plan
Most experts recommend:
- A follow-up visit a few months after starting treatment
- Regular check-ups, often every 6 to 12 months once things are stable
- Monthly self-checks with a hand mirror, looking for changes
Pick a date, like the first of the month, so the self-check becomes routine. Keep up with your regular well-woman exam too.
"Can I still have sex?"
Yes. Many people with well-controlled lichen sclerosus have comfortable sex. Treatment usually reduces tearing and pain over time. Plenty of lubricant helps, and dilators or pelvic floor therapy may help if the opening has narrowed. If sex still hurts, tell your clinician; there are more options to try.
When to see a doctor
Make an appointment with a gynecologist if you have:
- Vulvar itching that lasts more than a couple of weeks or keeps coming back
- White, thin or shiny patches on the vulva
- Pain during sex or skin that tears easily
- Scarring or narrowing of the vaginal opening
If you already have lichen sclerosus, see your clinician promptly for any new lump, sore or thickened area, or if symptoms flare despite treatment.
Some gynecologists have a special interest in vulvar skin conditions; ask when you book, "Does anyone in the practice focus on vulvar skin conditions?" Search our directory or browse gynecologists across New York City, Long Island and the Hudson Valley.
Frequently asked questions
What is lichen sclerosus?
Lichen sclerosus is a long-term inflammatory skin condition that most often affects the vulva and anal area. It causes itching, pain and thin, white, wrinkled skin.
Is lichen sclerosus contagious or an STI?
No. It isn't an infection and can't be passed to a partner. It isn't caused by poor hygiene either.
Can lichen sclerosus turn into cancer?
It carries a small increased risk of vulvar squamous cell cancer. Treating it consistently and keeping regular check-ups lowers the risk and helps catch changes early.
Is lichen sclerosus curable?
There's no cure, but prescription steroid ointment usually controls symptoms well and can prevent scarring.
Can lichen sclerosus go away on its own?
In adults it rarely goes away without treatment. Some children with lichen sclerosus improve around puberty, but they still need follow-up.
Sources
- ACOG — Diagnosis and Management of Vulvar Skin Disorders (Practice Bulletin 224)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH) — Lichen Sclerosus
- MedlinePlus — Lichen Sclerosus
- National Cancer Institute — Vulvar Cancer Treatment (PDQ)
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.