Vulval Discomfort and Pain

Symptoms of itching, burning and pain affect many women of all ages.  This can be very distressing and embarrassing but is often treatable following correct diagnosis.

Skin disorders are a frequent culprit and Lichen sclerosus a frequent offender.  This is not an infection but a chronic inflammatory disorder which affects the skin around the vagina and anus.  It is not contagious and cannot be “caught” from or transmitted to a partner.  As well as burning, itch and pain the condition causes the appearance of the vulva to change.  The skin becomes white and shiny.  In severe cases adhesions (scar tissue) can form making passing urine or intercourse difficult. It is not unusual for the skin to crack or fissure in this condition which makes infections such as thrush or bacterial infections take hold making things worse.

The cause is not fully understood but when one examines the skin from a patient with lichen sclerosus under a microscope one can see the body’s own immune cells attacking the skin.  This process causes the symptoms and signs.

Treatment involves a thorough assessment of factors which may be aggravating the condition.  Products such as shower gels and personal hygiene products, for example panty liners may contribute to the irritation caused by the disorder.  Patients with Diabetes or certain types of anaemia often suffer more symptoms of lichen sclerosus if these conditions are not optimised.

Specific treatment is also required in the form of strong steroid ointments or creams.  These work by stopping the immune system’s cells from attacking the skin.  Moisturising creams or gels are also used to help soften and protect the skin.  This makes  fissuring or cracking of the skin less likely, improving discomfort and reducing the risk of infection.

Over time the steroid cream will improve things to the point were symptoms resolve.  It is a good idea to continue caring for the vulval skin by avoiding soaps, perfumed products etc and keeping the skin soft and supple with moisturiser.  Flares ups of the Lichen sclerosus often occur requiring further use of the steroid cream or ointment but with correct diagnosis and management most patients are able to get on with life and have little disruption to their activities.  We do recommend regular checking of the skin as rarely a type of skin cancer can occur.  We encourage women to self examine regularly but many appreciate the reassurance of an expert assessment annually.

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