Lichen sclerosus (LS) is an inflammatory, auto immune skin condition that can affect any area of the body. It is most common in the skin around the genitals and causes the tissues to become pale, thin, and tight. Lichen sclerosus can affect both men and women, but more commonly presents in post menopausal women. The hallmark sign of LS is white patches (sometimes shaped like a figure of 8 or a keyhole) around the genital region that can itch, crack, tear, and cause pain with intercourse. In males, it can create narrowing of the opening at the end of the penis, causing difficulty urinating. In females, it can create restriction around the vagina, clitoris, and anus, making intercouse and bowel movements painful. The cause of LS is unknown, but it can be related to hormonal changes, trauma, and immune dysfunction. It is not contagious and is not spread by sexual contact. This condition may be more common than we realize, as we are seeing more and more cases in
young females in the clinic.
Treatment for lichens generally consists of steroid ointment that reduces inflammation and restores plumpness to the tissues. The goal is to reduce scarring, reduce pain and itching, and improve tissue color and quality. I have seen patients improve DRAMATICALLY after even just two weeks of using the creams as prescribed.
Pelvic therapy is imperative in this population. When you have pain in the genital area the pelvic floor muscles can also become tight and tense, leading to more pain. When our muscles become tight, this creates more problems like painful urination, urinary leakage, vaginal tearing, and painful intercourse. Once you've started taking the prescribed medication, the muscles still need rehab! A specialized pelvic floor therapist can perform a vaginal exam, testing for muscle tension and strength. For the vast majority of patients with LS, the goal is to relax and lengthen the pelvic floor muscles - NOT to squeeze, kegel, or strengthen. Your therapist will apply gentle manual therapy to help restore tissue nutrition, increase blood flow, and improve mobility. This reduces the risk of tissue scarring, and also decreases your pain. They will also teach you proper stretches and techniques that you can perform at home. Your pelvic PT/OT will also teach you about the importance of gut health, vaginal pH balance, and reducing acidity in your diet. All of these things together help reduce the severity of LS on your quality of life. So not only can therapy help improve tissue health, but mental health!
This condition can be distressing, but medical and therapeutic interventions can restore the quality of your tissues and quality of life! If you have been diagnosed with lichen sclerosus, you can talk to a pelvic health therapist about treatment. This is a treatable problem, and most insurances cover therapy services. We are here to help you on your journey to restoring great health!
Today's blog written by Jovie Murtha