Lichen Sclerosis can affect women, men and even children, but the majority of cases occur in women. Tiny skin lesions that look like little white spots develop on the vulva, anus and sometimes the labia and clitoris.
In boys and men it occurs at the tip of the penis and is usually corrected by a circumcision. Rarely, it can affect other areas of the body, but it is most common in the genital region.
The white spots are intensely itchy, causing the sufferer to scratch. In turn, repeated scratching can exacerbate the condition and lead to scarring. Eventually the skin thins out and can crack and bleed. A woman may find that sexual intercourse becomes painful and that her partner tears her during sex. She may also find it difficult to urinate as it could burn due to the skin lesions.
If the condition is not managed, the labia could fuse together and the vaginal cavity atrophy. This narrowing makes sexual intercourse impossible. In rare cases, the vaginal opening may close altogether and this requires surgery - called a Fenton's Procedure - to correct. This would be to remove excess scar tissue at the vulva and widen the vaginal opening.
There is a small risk that women with lichen sclerosus will go on to develop skin cancer (between 3 and 6% of sufferers) and the condition is directly related to immune system disorder (auto-immunity).
Implications For Conception And Pregnancy
Obviously if sex is painful and difficult, or impossible, then getting pregnant can be a challenge. Your first step is the diagnosis and management of your condition. Unfortunately there is no cure for lichen sclerosus but it can be controlled so that you can live a normal life.
Sometimes hormone treatments are offered but these will not be suitable for use in pregnancy.
Steroid cream applied to the area daily is the most common treatment, such as Dermovate cream which will reduce inflammation. If used regularly and long-term, your skin may recover and it may be possible to resume a healthy sex life and to achieve a pregnancy. You will get 'flare ups' in the future, but you can manage these.
Dermovate cream, and some other steroid creams, are suitable for use in pregnancy and breast feeding. If you are thinking of starting a family, talk to your dermatologist.
Childbirth
Many women are afraid of giving birth, quite understandably, with this type of genital condition. However, women who manage their condition effectively have given birth vaginally with minimal after-effects. The skin around the perineum will be more prone to splitting, so massaging a lubricant into the area for a few weeks prior to the birth may help. Also choose a position which reduces the risk of tearing. Speak to your midwife or nurse midwife for advice on positioning.
Sometimes, if your condition is severe, a caesarean section may be advised.
