Sexual Health Q&A

How is lichen sclerosus diagnosed and treated?

Doctors can often diagnose lichen sclerosis, a skin disorder, based on a patient’s symptoms and a visual examination. However, sometimes a biopsy is ordered. In that case, a small section of the affected area is removed and sent to a lab for analysis.

Depending on the severity, lichen sclerosis may be treated with medication, surgery, or other methods.

Medication

Corticosteroid ointments and creams are one option. These medications can reduce inflammation and are applied directly to the affected area, usually once a day for the first few weeks. In time, a patient may need to apply the ointment only once or twice a week.

Surgery

More serious cases of lichen sclerosus might be treated with surgery.

For men, circumcision – surgical removal of the foreskin – might help.

Surgery on the vulva (the area surrounding the vaginal entrance) might be considered for women, especially if they are experiencing sexual pain as a consequence of lichen sclerosus. The condition can cause changes in genital anatomy, narrowing the vagina and thinning the vaginal lining. Both can make penetration quite uncomfortable. Research published in 2016 suggested that vulvar surgery can reduce sexual pain.

Other methods

As an alternative to surgery, women with lichen sclerosis might try using vaginal dilators. These plastic cylinders are inserted into the vagina and gently stretch it so that a penis will fit comfortably.

If penetration is painful, couples might also explore other ways to be intimate that do not involve intercourse. Kissing and touching can still make partners feel close to one another. Sometimes, couples have trouble moving in this direction, but a sex therapist can help them talk about what they want and need out of their relationship.