Lichen Sclerosus: What You Need to Know About This Common Yet Overlooked Vulvar Condition

Have you heard of Lichen Sclerosus (LS)?
It’s a chronic skin condition that affects the genital and anal areas, though it can appear elsewhere on the body. While LS can affect anyone, it’s most common in women after menopause. However, it may also occur in men and children, though less frequently.

At FeminaPT, we’re passionate about raising awareness around vulvar health conditions like LS—and how pelvic floor physical therapy can play an essential role in your healing journey.

What Does Lichen Sclerosus Look Like?

Lichen sclerosus typically presents as:

• Thin, white, shiny, or wrinkled patches of skin

• Areas that may feel itchy, sore, or painful

• Fragile skin that tears or bruises easily

In more advanced cases, LS may cause:

• Scarring

• Labial fusion (where the labia stick together)

• Clitoral adhesions (clitoral phimosis)

• Vaginal atrophy (thinning of vaginal tissues)

These changes can significantly affect sexual health, urination, and daily comfort.

What Causes Lichen Sclerosus?

The exact cause of LS isn’t fully understood, but research suggests several contributing factors:

• Hormonal changes, especially post-menopause

• Autoimmune responses, where the immune system mistakenly attacks healthy skin

• Genetics—it sometimes runs in families

• Oxidative stress, which involves damage from unstable molecules in the body

Many people with LS also have other autoimmune conditions, such as thyroid disease or vitiligo.

How Is LS Diagnosed?

A healthcare provider can often diagnose LS by examining the affected skin. However, if there’s any uncertainty or concern for vulvar cancer (which LS slightly increases the risk for), a biopsy may be performed.

Treatment Options for Lichen Sclerosus

The primary goals of LS treatment are to:

• Relieve symptoms

• Prevent progression

• Reduce cancer risk

Common treatments include:

1. Topical Steroid Creams:

The gold standard for LS treatment, potent corticosteroid creams reduce inflammation and promote healing.

2. Immune-Modulating Creams:

If steroids aren’t effective, medications like tacrolimus or pimecrolimus may be used to calm immune responses.

3. Hormone Therapy:

Hormonal deficiency often coexists with LS, especially after menopause. In some cases, topical estrogen may be prescribed to improve vulvar tissue health and reduce dryness or itching alongside other treatments.

Important: Early treatment is key to preventing permanent scarring or functional impairments.

Why Pelvic Floor Physical Therapy Matters for LS

While medical treatments focus on inflammation and skin health, pelvic floor physical therapy can play a crucial role in improving comfort, function, and quality of life for people living with LS.

At FeminaPT, our pelvic health physical therapists are specially trained to address:

• Pain with intimacy (dyspareunia)

• Clitoral phimosis (adhesion and restriction of the clitoral hood)

• Pelvic floor muscle tension or dysfunction

How Does It Work?

We use gentle, evidence-based techniques such as:

• Myofascial release

• Soft tissue mobilization

• Clitoral hood mobilization (to gently address adhesions and improve tissue mobility)

• Breathwork and nervous system regulation to reduce protective muscle guarding

These hands-on therapies help to:

• Improve circulation and tissue flexibility

• Reduce pain

• Restore normal movement and comfort during daily activities and sexual function

Supporting Research:

A 2015 study published in The Journal of Women's Health Physical Therapy showed that specific myofascial release techniques led to significant improvement in clitoral phimosis and painful intercourse among patients with LS.²

Additionally, a 2024 review in the Journal of Personalized Medicine emphasized the need for a multidisciplinary approach—including physical therapy—for optimal vulvar health outcomes.³

Why Stress & Emotional Support Also Matter

Living with LS can be physically and emotionally challenging. Stress may worsen symptoms or lead to protective pelvic muscle tension. Our holistic care approach includes:

• Stress-reduction techniques

• Breathing exercises

• Education about pelvic health

• Support for body confidence and sexual well-being

The Femina PT Takeaway

Lichen sclerosus doesn’t just affect the skin—it can impact daily function, sexual health, and overall well-being. However, with the right medical treatment and pelvic floor physical therapy, many people experience significant relief.

If you notice:

• Persistent itching

• White or wrinkled patches of skin

• Pain with intimacy or urination

Don’t wait. Seek care from your healthcare provider and ask about integrating pelvic floor therapy into your treatment plan.

Our team at FeminaPT is here to support you through every step of your healing journey.

References

1. De Luca DA, et al. Lichen sclerosus: The 2023 update. Front Med (Lausanne). 2023;10:1106318.

2. Morrison P, et al. The Use of Specific Myofascial Release Techniques by a Physical Therapist to Treat Clitoral Phimosis and Dyspareunia. J Women's Health Phys Ther. 2015;39(1):17-28.

3. Popa A, et al. Vulvar Lichen Sclerosus: Navigating Sex Hormone Dynamics and Pioneering Personalized Treatment Paradigm. J Pers Med. 2024;14(1):76.