An itchy vulva can be caused by few different things—a yeast infection, a sexually transmitted infection or even an irritating soap or detergent.
Less commonly, itchiness can be caused by lichen sclerosus, a chronic autoimmune skin condition that affects the vulva. (It also can affect the penis, but this is very rare.) As with other autoimmune diseases, it’s not clear why the body’s immune system targets this healthy tissue.
“You can have it any point of life, but the most common time for a new diagnosis is before puberty or after menopause, so there’s likely some sort of relationship with low estrogen levels,” says UNC Health family medicine physician Debbie Phipps, MD.
Having another autoimmune disorder or thyroid disease also puts you at higher risk for lichen sclerosus.
Lichen sclerosus can’t be cured, but it can be treated so that you don’t have to suffer the itch. Here’s what you need to know if you think you might have this condition.
Lichen Sclerosus Symptoms
Lichen sclerosus causes changes to the external skin around the vagina. That skin becomes thinner, though there may also be thicker patches as skin scars and tightens. It may cause white patches that you will be able to see, mostly on the vulva, but the discoloration can expand back through the perineum, the skin between the vagina and anus. Sometimes, this white skin will form a figure eight from both lips of the labia, through the perineum and around the anus.
These skin changes cause itching, and as the skin becomes more fragile, the risk for additional injury.
“It can progress to what seem like tiny paper cuts on the skin that are painful during sex or when you urinate,” Dr. Phipps says.
If left untreated, the skin will continue to break down so that the labia change shape. It is possible for scar tissue to build up and block the opening to the urethra or vagina, requiring surgery.
Lichen sclerosus is not contagious and can’t be transmitted during sex or by sharing clothes.
Diagnosing Lichen Sclerosus
Your first clue you have lichen sclerosus could be itching, or your doctor might see the white spots during a routine pelvic exam before you notice symptoms.
“The most classic case is when someone has itching and thinks they have a yeast infection,” Dr. Phipps says. “If you treat for yeast, and the itching is not better, then this should be considered as something else that could cause the itchiness.”
Some providers may want to take a biopsy, but Dr. Phipps says it’s possible to make the diagnosis based on appearance and symptoms.
“With a biopsy, we can be 100 percent certain it’s not something else, so if there’s a chance it could be cancer or precancer, then a biopsy can help with the right diagnosis,” Dr. Phipps says. “But if everything suggests lichen sclerosus, it’s OK to start treating and confirm the diagnosis if you respond to treatment.”
Treatment for Lichen Sclerosus and Cancer Prevention
The first treatment for lichen sclerosus is a topical steroid cream that you apply to the vulva. The steroid reduces the immune system’s attack on the skin.
“Lichen sclerosus responds really well to this treatment, and most people find that it treats their symptoms in a dramatically quick fashion,” Dr. Phipps says.
Because lichen sclerosus is a chronic condition, you’ll have to use the steroid cream regularly for the rest of your life. Because topical steroids address symptoms so well, Dr. Phipps says it’s common for people to forget to apply them and then deal with a flare of symptoms.
Topical steroids also provide another benefit: cancer prevention.
“If left untreated, about 3 to 5 percent of lichen sclerosus cases can progress to squamous cell carcinoma,” Dr. Phipps says. “The topical steroids prevent that progression.”
If your symptoms don’t respond to topical steroids, your provider may prescribe another type of topical cream, calcineurin inhibitors, which block the inflammatory response to the immune system. This treatment has not been shown to prevent cancer. Other treatments, including lasers and platelet-rich plasma injections have been studied for this condition, Dr. Phipps says, but are not yet approved for use.
Even if your lichen sclerosus symptoms are well-controlled, it’s important to see your provider regularly due to the slightly increased risk of skin cancer and the risk for other autoimmune diseases.
“The risk for cancer is low, especially with treatment, but it’s still important to watch for any change in texture, areas that look whiter than others or areas that have bled and aren’t healing,” Dr. Phipps says. “When people speak up about any skin changes, we can catch it in a precancerous stage.”
Just as having another autoimmune disorder puts you at higher risk for lichen sclerosus, this diagnosis will increase your risk for other autoimmune diseases, particularly those associated with the thyroid.
“About 30 percent of people with lichen sclerosus will also have a hypothyroid diagnosis, such as Hashimoto’s disease,” Dr. Phipps says. “It’s important to keep an eye on the thyroid and check the TSH levels once a year. Otherwise, treatment can keep lichen sclerosus well-controlled and it shouldn’t affect your function or daily life.”
If you’re experiencing discomfort in the vulva or vagina, talk to your doctor. If you need a doctor, find one near you.