Lichen Sclerosus in Women: Symptoms, Causes and Treatment

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 and white, thin, crinkled patches of skin, and it’s most common after menopause. It isn’t contagious or caused by poor hygiene. There’s no cure, but prescription treatment usually controls symptoms well, and regular care helps prevent scarring and lowers the small risk of vulvar cancer.

Key takeaways

• The most common symptom is persistent, often severe vulvar itching, which can be worse at night.
• Lichen sclerosus is often mistaken for a yeast infection or normal menopause dryness. In one large study, women had symptoms for an average of 5 years before being diagnosed.
• It isn’t a sexually transmitted infection, and it can’t be passed to a partner.
• Treatment with a prescription steroid ointment controls symptoms for most women.
• Untreated lichen sclerosus can cause scarring and slightly raises the risk of vulvar cancer. Consistent treatment and regular checkups lower that risk.

What is lichen sclerosus?

Lichen sclerosus is a chronic inflammatory skin condition. It most often affects the vulva (the outer genital area) and the skin around the anus, though it can occasionally appear on other parts of the body.

It can affect anyone, but it’s most common in women after menopause. It also occurs in girls before puberty and, less often, in men. Because it affects intimate areas, many women feel embarrassed to bring it up, and it’s likely underdiagnosed.

What are the symptoms of lichen sclerosus?

The most common symptom is itching that is persistent, often intense, and sometimes bad enough to wake you at night. Other symptoms include:

• White, shiny or thin patches of skin that may look crinkled, like tissue paper
• Skin that tears, cracks or bruises easily
• Soreness, burning or raw-feeling skin
• Pain during sex
• Pain when urinating or having a bowel movement
• Small blood blisters or open sores

Some women have very few symptoms, and the condition is noticed only during a pelvic exam.

What causes lichen sclerosus?

The exact cause isn’t known. Researchers believe the immune system plays a role, and lichen sclerosus is more common in people with autoimmune conditions such as thyroid disease or vitiligo. Low estrogen levels and genetics may also contribute, since it sometimes runs in families.

Lichen sclerosus is not caused by poor hygiene, it isn’t an infection, and it isn’t contagious.

Lichen sclerosus vs. yeast infection vs. menopause dryness

Lichen sclerosus is often mistaken for other common conditions, which can delay the right treatment. If repeated yeast treatments haven’t helped, or itching keeps coming back, ask your doctor to check for lichen sclerosus.

How lichen sclerosus compares with two conditions it’s often mistaken for

Sign	Lichen sclerosus	Yeast infection	Menopause dryness (genitourinary syndrome of menopause)
Main symptom	Intense, long-lasting itching	Itching and burning	Dryness, irritation, pain with sex
Skin appearance	White, shiny, thin or crinkled patches	Red, swollen skin	Pale, thin, dry tissue
Discharge	Usually none	Often thick and white	Usually little or none
Pattern	Chronic, with flare-ups	Comes on over days; clears with treatment	Gradual and ongoing after menopause
Responds to yeast treatment?	No	Yes	No

How is lichen sclerosus diagnosed?

A doctor can often recognize lichen sclerosus during a pelvic exam. To confirm it, they may take a small skin sample (biopsy), which is a quick procedure done with local numbing. Gynecologists, dermatologists and vulvar specialists all diagnose and treat lichen sclerosus.

How is lichen sclerosus treated?

There’s no cure, but treatment works well for most women. The standard treatment is a strong prescription steroid ointment applied to the affected skin. It usually relieves itching within weeks and can help the skin return to a more normal color and texture.

Because lichen sclerosus is chronic, many women continue using the ointment less often as maintenance, as directed by their doctor, to keep symptoms from returning. Used as prescribed, it’s considered safe for long-term use on this skin.

Gentle daily care can also help:

• Wash with plain water or a soap substitute, and avoid scented soaps, bubble baths, wipes and sprays.
• Use a plain, fragrance-free moisturizer or barrier ointment to protect the skin.
• Wear loose cotton underwear and avoid tight clothing.
• Use a lubricant during sex to reduce friction and tearing.
• Try not to scratch, which can damage the skin further.

Is lichen sclerosus linked to cancer?

Lichen sclerosus slightly raises the risk of vulvar cancer in the affected skin. In a 2022 review of more than 14,000 women with vulvar lichen sclerosus, about 2% developed vulvar cancer. The risk is higher with older age and when the condition goes untreated.

The encouraging news is that consistent treatment appears to lower this risk. In one long-term study of 507 women, none of those who used their treatment as directed developed vulvar cancer or precancer, compared with about 5% of those who didn’t follow treatment fully.

That’s why regular checkups, usually at least once a year, are important even when symptoms are under control.

When should you see a doctor?

See a gynecologist or dermatologist if you notice:

• Vulvar itching that lasts more than a couple of weeks or keeps coming back
• White, shiny, thin or crinkled patches of skin
• Itching that doesn’t improve with yeast infection treatment
• New pain with sex, urination or bowel movements

If you’ve already been diagnosed, see your doctor promptly if you notice a lump, a sore that doesn’t heal, a thickened area of skin, or symptoms that no longer improve with your usual treatment.

Frequently asked questions

Is lichen sclerosus contagious or an STI?

No. Lichen sclerosus isn’t an infection, isn’t sexually transmitted, and can’t be passed to a partner.

Can lichen sclerosus be cured?

There’s no cure, but treatment controls symptoms for most women. Many women stay comfortable for long periods with maintenance treatment and regular checkups.

Can lichen sclerosus go away on its own?

It rarely goes away on its own in adults. Without treatment, it can cause scarring that changes the shape of the vulva and narrows the vaginal opening, so it’s important to get treated even if symptoms are mild.

Does lichen sclerosus cause skin cancer elsewhere on the body?

The increased cancer risk applies to the affected genital skin. Lichen sclerosus isn’t known to raise the risk of skin cancer on other parts of the body. If you have other skin cancer concerns, ask your dermatologist.

Is lichen sclerosus the same as lichen planus or scleroderma?

No. Lichen planus is a different inflammatory skin condition that can also affect the vulva, and scleroderma (morphea) is a separate condition that hardens the skin. They have similar names, but they’re diagnosed and treated differently.

Is lichen sclerosus caused by menopause?

Menopause doesn’t directly cause lichen sclerosus, but it’s most common after menopause, and low estrogen may play a role. It’s also easy to confuse with menopause dryness, so persistent itching shouldn’t be dismissed as “just menopause.”

Can I have sex if I have lichen sclerosus?

Yes. Many women have comfortable sex once lichen sclerosus is well controlled. Using a lubricant helps, and if sex is painful because of tightening or scarring, talk with your doctor about treatment options.

Sources

• Lee A, et al. Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women. JAMA Dermatology, 2015
• Vieira-Baptista P, et al. Risk of development of vulvar cancer in women with lichen sclerosus or lichen planus: a systematic review. Journal of Lower Genital Tract Disease, 2022