Some health conditions come with awareness campaigns, celebrity spokespeople, and brightly coloured ribbons. And then there are the ones no one talks about—the ones that affect people’s most intimate areas, leaving them feeling embarrassed, dismissed, or simply unaware that their symptoms even have a name.
Lichen sclerosus (LS) is one of those conditions. It’s common, it’s underdiagnosed, and it can have a huge impact on quality of life. Yet, too many women (and some men) go years without the right diagnosis—often because they’ve been told it’s thrush, irritation, or just “one of those things.”
So, let’s talk about it.
What is Lichen Sclerosus?
Lichen sclerosus is a chronic inflammatory skin condition that most often affects the vulva and anal area, though it can appear on other parts of the body. It’s thought to be autoimmune in nature, meaning the immune system mistakenly attacks the skin, causing thinning, inflammation, and scarring over time.
It can happen at any age, sometimes even in children, but it’s most commonly diagnosed in postmenopausal women. It’s not contagious, it’s not thrush or an STI, and it’s definitely not “just” a bit of dry skin or dermatitis.
Symptoms: More Than Just an Itch
The most common symptom is intense itching—the kind that can keep you awake at night. But LS isn’t just about being itchy. Other signs include:
- White, thin, or shiny skin (especially around the vulva)
- Pain or burning (especially during sex or when passing urine)
- Tears, splitting, or easy bruising of the skin which can cause discomfort even when doing low impact movement like walking or swimming.
- Scarring and shrinking of the vulva over time, which can change its appearance and cause discomfort
- Tightening of the vaginal opening, which can make intercourse painful or impossible
For some, the symptoms are mild. For others, they can be life-altering. And because LS can cause permanent scarring if left untreated, early diagnosis is key.
Why is it so Often Missed?
One of the biggest problems with LS is how often it’s misdiagnosed or dismissed. Many women are told they just have thrush (despite antifungal treatments being ineffective- sometimes they are partially effective because there is a ‘superimposed’ infection). Others are given steroid creams for irritation without proper investigation. And because LS affects an area we’re often reluctant to talk about—even with doctors—many people suffer in silence.
Even when women do seek help, not all GPs are familiar with LS. A quick look during an appointment might not be enough to catch it, and unless the doctor is experienced in vulval dermatology, it can be mistaken for eczema or just “sensitive skin.”
The Risk of Vulval Cancer
Here’s the part that doesn’t get talked about enough: LS slightly increases the risk of vulval cancer. The risk is still low, but it’s there—around 4-5% of women with LS will develop vulval cancer, but this does tend to be in the older age group. This is another reason why proper management and regular check-ups are so important.
Treatment: What Actually Works?
The good news? LS can be managed. There’s no outright cure, but with the right treatment, symptoms can be controlled, and scarring can often be prevented or minimised.
The gold-standard treatment is a strong steroid ointment, such as clobetasol propionate (dermovate) or mometasone ointments. It might sound counterintuitive—especially since many of us are told steroids thin the skin—but in LS, steroids calm the inflammation that causes the skin to form scar tissue. Used correctly, they’re safe and VERY effective.
At initial presentation, the stronger steroids usually need to be used for several weeks, but in the longer term, once the initial flare is under control and in remission, a much less potent steroid ointment should be used regularly and in the long term. Hydrocortisone 1% ointment which is available over the counter is usually adequate for most women maintaining their condition. If a flare up occurs, the stronger steroid preparation can be used for 4-6 weeks until it settles again. LS tends to continue in this pattern lifelong.
Other treatments and management options include:
- Moisturisers and barrier creams to protect the skin and keep it comfortable
- Pain relief (such as lidocaine gel for discomfort while getting a flare under control)
- Good vulval skincare (avoiding soaps, perfumes, and anything that might irritate)
- Regular monitoring by a healthcare professional who is familiar with the condition
- In some cases, surgical intervention if scarring has caused significant issues
Living with Lichen Sclerosus
Being told you have LS can feel overwhelming, but here’s the good news—you’re not alone, and there is effective treatment. With the right care, you can manage symptoms, protect your skin, and carry on with life as normal.
If you’ve been struggling with itching, pain, or other symptoms and haven’t had any clear answers, don’t be afraid to push for a proper diagnosis. A referral to a gynaecologist or dermatologist who specialises in vulval health can make all the difference. And if you’re looking for expert advice, compassionate care, and a place where your concerns will be taken seriously, my clinic is also here to help.
Most importantly, let’s talk about LS. The more we break the silence around conditions like this, the more women will get the diagnosis and support they deserve. You’re not alone, and you don’t have to just put up with it.
