Vulvar Lichen Sclerosus

What it is

Lichen sclerosus is a chronic inflammatory skin condition that mainly affects the vulva and the area around the anus. It is more common after menopause but also occurs in young women and girls. It causes intense itching, especially at night, burning, white patches and thin, shiny skin, with fissures, minor bleeding and pain during intercourse. Without treatment, it can lead to the flattening of the labia minora and narrowing of the vaginal entrance, and there is a small increased risk of vulvar cancer, which makes follow-up important. Diagnosis is clinical, confirmed by biopsy when there is doubt. The baseline treatment is a high-potency topical corticosteroid, with a maintenance regimen; moisturizers, local care and, in selected cases, CO₂ laser help control symptoms. Long-term periodic follow-up is recommended.

Most common symptoms

• Intense vulvar itching that tends to worsen at night
• Burning sensation in the intimate area
• White patches and thin, shiny or wrinkled skin
• Fissures, cracks and minor bleeding
• Pain or discomfort during intercourse
• Flattening of the labia minora or narrowing of the vaginal entrance
• Similar skin changes around the anus

Causes and risk factors

• Autoimmune skin reaction, with genetic predisposition
• Menopause and the drop in estrogen, when it is most common
• Personal or family history of autoimmune diseases, such as thyroid disorders
• Friction, moisture and irritating products, which worsen the lesions
• Can also occur in girls before puberty

How it is diagnosed

The diagnosis of lichen sclerosus is essentially clinical. During the consultation, your gynecologist listens to the history of itching and burning, asks about other autoimmune diseases, and carefully examines the vulva and perianal area, with the help of vulvoscopy when indicated. When the appearance of the skin is uncertain, when the lesions differ from the usual pattern, or when the response to treatment is not as expected, a small biopsy confirms the diagnosis and rules out other causes.

How we treat it at Femi Saúde

The baseline treatment is a high-potency topical corticosteroid, applied in a more intensive initial regimen and then for maintenance, to control inflammation and reduce the chance of scarring. The gynecology team at Femi Saúde guides local care, such as the use of moisturizers and emollients and reducing irritants, and, in selected cases with persistent symptoms, may suggest intimate CO₂ laser as a complement. When there is significant narrowing of the vaginal entrance, corrective procedures may be considered. Because this is a chronic condition, long-term periodic follow-up is part of the plan, which is individualized for each case.

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