lichen sclerosus

Lichen sclerosus is a skin condition involving the skin around the vaginal opening that affects approximately 3-5% of all postmenopausal women.  It is a common cause for introital irritation that is often not diagnosed properly and can result in progressive symptoms of itching, burning and a constant feeling of dryness.  When not treated, it can result in scarring of the vaginal opening and an increased risk of vulvar cancer.  It commonly will trigger the pelvic muscles to become hypertonic and therefore trigger all the problems we have discussed concerning high tone pelvic floor dysfunction and pelvic floor myalgia.  A biopsy can be done to establish the diagnosis, and topical use of a steroid will quickly resolve the symptoms in the majority of patients.  While it is more common in the postmenopausal woman it is a dermatologic condition that can occur at all ages.  It can involve the oral mucous membranes as well as the vaginal canal.  The most common clinical situation that I see is a patient who has been told that she has vaginal atrophy causing the symptoms, yet the use of estrogen cream does not make the problem disappear.  Because it is a chronic skin condition symptoms will quickly return once a topical steroid is stopped. Therefore, the long-term use of this type of therapy is required.