Sexual Health Q&A

What is lichen sclerosus and whom does it affect?

Lichen sclerosus is a rare skin condition. Most of the time, it develops on the genitals or near the anus, although it can also form on other parts of the body, such as the upper arms, chest, back, or shoulders.

Lichen sclerosus is marked by white patches on the skin, which can be itchy or sore. Symptoms may come and go over a period of several years. There is no cure, but treatments to manage symptoms are available.

Men and women of all ages can have lichen sclerosus. But it is most common in women, especially those who have gone through menopause. Lichen sclerosus is thought to affect 1 in 1,000 women compared to 1 in 100,000 men.

In men, the patches usually appear at the tip of the penis. (The anus is not typically affected in men.) Uncircumcised men might have trouble pulling their foreskin back when they urinate. Some men with lichen sclerosus have painful erections.

In women, lichen sclerosis generally appears on the vulva (the area around the vagina). Itching may be especially bothersome at night. If there are patches near the anus, passing stools can be uncomfortable.

Left untreated, lichen sclerosis can lead to changes in the vulva. Scarring can narrow the entrance to the vagina and eventually, tissues that line the vagina can become thin and tear during intercourse.

As a result, many women with lichen sclerosis experience sexual discomfort or pain. The vagina may become too narrow for a penis to enter. And penetration may irritate tears in the vagina, making them bleed. Some women with lichen sclerosus avoid having sex, which often leads to emotional and relationship stress.

Patients with lichen sclerosus might be at higher risk for developing vulvar cancer or penile cancer, but the increase in risk is small.