What is Lichen Sclerosus?

Lichen sclerosus is an inflammatory condition that impacts the skin in the genital region. Current research suggests that it is driven by an autoimmune process that can progress over time. The condition is relatively rare and may impact between 1 in 300 to 1 in 1000 people, with females being six times more likely to be impacted. Still, 3% of the population includes more than 5 million women in the United States.

Lichens can cause the sensation of dryness and irritation on the skin of the labia, clitoris, tip of the penis, foreskin or perineum. Symptoms may also include pain and itchiness in the affected areas. Commonly, the skin in these areas become white and patchy over time. Affected skin can also become thinner or more friable, leading to increased risk for tearing and microtraumas, especially during activities like physical intimacy. Additionally, scar tissue and adhesions can form over time, putting people with lichens at risk for challenges with bladder and bowel dysfunction. Symptoms are often worse around menstruation and in the postmenopausal years due to hormonal changes.

Many people with lichens first believe that it’s a yeast infection. If you’re having what you believe to be recurring yeast infections, it’s important to get tested for yeast. Although it’s more convenient when you can treat something at home without going to the doctor, there are many genital disorders that are often confused for yeast infections, and when this happens, there is often a delay in diagnosis and treatment of the root cause. With lichens, many report initial symptoms feeling similar to that of a yeast infection, but located along the labia rather than internally. 

Lichen sclerosus is treated medically with topical steroids and other ointments to help reduce skin inflammation. Sitz baths, alongside usage of topical steroid creams, can be very beneficial for symptom relief. Vaginal moisturizers may also reduce symptoms. Because hormonal changes can exacerbate symptoms, hormonal management may also be helpful. There is no cure for lichens, but symptoms can be managed or sometimes eliminated with treatment.

Lichens Sclerosus & Lichens Planus

Lichens sclerosus and lichens planus are very similar conditions. The main difference between them is that lichens planus can involve the mucosal membranes or skin of the mouth as well as other regions of the body, including the genitals. Lichens sclerosus typically only impacts the skin of the genitals. If you’ve been diagnosed with lichens planus, and it’s impacting the skin of the vulva and vagina, you will still benefit from skilled pelvic floor physical or occupational therapy. 

Pelvic Floor Therapy to Manage Lichens

Many of the symptoms of lichen sclerosis like pain and itching overlap with what pelvic floor therapists see. So while medical treatment for lichen sclerosis must come first, a subsequent part of the journey is often to seek out pelvic floor therapy. Pelvic floor physical or occupational therapy can help with symptom management. 

Pelvic Pain

With any chronic condition to the area of the genitals, abdomen, or pelvic floor, you may be at risk for developing a pain cycle that makes it harder to have a pain-free experience. Often, our pelvic floor muscles can become tense or guarded in response to sensations of inflammation or irritation. This guarding reaction increases tone in the pelvic floor (known as hypertonicity or overactivity), compresses nerves, and making it harder for blood and lymph flow to occur. Consistent muscle tension increases the likelihood of experiencing pelvic pain. A pelvic floor physical or occupational therapist can help figure out what tools for working with pelvic pain related to lichens, including stretches, breathing techniques, pain management tools, and manual self-release. 

Scar Massage

Scarring caused by lichens sclerosus be both uncomfortable and can lead to clitoral adhesions and impaired bowel and bladder habits. A pelvic floor therapist trained in internal and external manual techniques can support with increasing the blood and lymph flow to any adhesions formed, to help decrease pain, improve streams and ease of urination and defecation, and allow for pleasure. 

Pain with Sex

Unfortunately, pain with sex with lichens sclerosus is extremely common. This can manifest as discomfort with light touch to the clitoral region and labia, as well as pain or burning with penetrative sex. A trained pelvic floor therapist may help educate you about breathing techniques to release tight muscles, mobility training, and manual therapy and mayo facial release to help support these tissues. Additionally, many people with lichens may benefit from guided dilator training to help support decreased pain with penetration. 

Pregnancy

There is unfortunately minimal literature on the connection between lichens sclerosus and pregnancy and birth. Working with a pelvic floor therapist can help consciously lengthen the muscles of the pelvic floor, which will not only help you open your muscles during birth, and could also help with managing symptoms associated with lichens. Getting cleared by your OBGYN for perineal massage at about 34 weeks pregnant may also be helpful in reducing tearing during labor. There is some research to suggest that for folks with lichens sclerosus, symptoms remain unchanged or decrease during pregnancy, and that some may experience an increase in symptoms postpartum.

Lichens sclerosus and planus are challenging conditions, but with the help of a team of providers, including pelvic floor physical or occupational therapy, you can get the support you need to decrease pain and discomfort. 

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This article was written by Mirah Sand OTR/L. They are a pelvic floor occupational therapist who is certified Pregnancy and Postpartum Corrective Exercise Specialist, and has received advanced pelvic health training through Herman and Wallace Pelvic Rehabilitation Institute.