Pelvic Floor Physical Therapy for Lichen Sclerosus

What is Lichen Sclerosus

Lichen sclerosus is a chronic inflammatory condition of the skin. The skin develops white colored patches that are thin , dry, shiny and often itchy. It commonly affects the genital area and is typically more commonly seen in women. Vulvar lichen sclerosus often affects the skin of the vulva and the anal area. Research does not agree on the cause of Lichen Sclerosus but strongly points towards the immune system and hormonal influence. Simply put the immune system is attacking the tissue of the vulva causing thinning, discoloration, itching, scarring and burning. It is sometimes referred to as a cigarette paper appearance of the vulva due to the white, shinny changes in the skin. While hormones are not the cause estrogen imbalance can exacerbate the symptoms in many women. A great resource for all things Lichen Sclerosis is Lichen Sclerosus Support Network

Symptoms of Lichen Sclerosus

It is a progressive condition and may lead to changes in the architecture of the vulvar tissue. These skin patches around the vaginal opening can become painful and sensitive to pressure. Changes such as resorption of a labia, adherence of the clitoris, decreased sensations around the clitoral anatomy and fusing of vulvar parts are commonly seen in vulvar Lichen Sclerosus.

Sometimes it leads to thinning of the labia folds and other times scarring around the labia. It can affect the clitoral hood and tissue surrounding it. Sometimes it can be asymptomatic and other times it can lead to paper-cut like tearing around the vaginal opening. Due to the nature of the disease Lichen Sclerosis invariably always leads to painful penetration such as partnered sex, vaginal exams or self play.

A woman hand holding picture of a shrunk orange fruit insinuating vaginal scarring with Lichen sclerosus

Sexual health problems with Lichen Sclerosus 

  • Pain with sex
  • Intimacy issues
  • Decreased sexual desire
  • Fear of tearing
  • Body image issues
  • Shame
  • Painful pelvic exams

Top Tips for anyone with Lichen Sclerosus

  • Not everything white and smelly around your vagina is yeast! Lichen Sclerosus often gets misdiagnosed as a yeast infection. Many women reported having several “yeast infections” that were not responding to over the counter medicine before they were diagnosed with Lichen Sclerosus. If your intuition muscle is telling you it’s not yeast ….keep seeing a different doctor till someone takes a good look and runs a diagnostic biopsy.
  • If you are using any new product such as a lubricant over your vulva/vagina. Test it first. Use a small dab on one part of the vulva for 2-3 days. If you don’t have any adverse reaction then test the same product in the same small amount over the vaginal opening. And yes vagina and vulva are not the same! Once you have proven it safe on both zip codes you can start using it during sexy-time!
  • If you have Lichen sclerosus and you travel a lot. I recommend carrying a Lichen Sclerosus kit so you are never caught off-guard. Because the stress of traveling and stress of being stressed can mean a flare-up for some women. Travel Tips for you;

            -Carry your medication or vaseline or Aquaphor

            -Carry a portable Sitz bath

            -Carry vulvar ice pack or warm compress

            -Comfy loose undies or honestly boxer shorts! 

A quote card insinuating the struggle of chronic pain such as vaginal scarring with Lichen sclerosus

Diagnosis and treatment of Lichen Sclerosus

It is  considered a rare disease at the intersection of gynecology and dermatology. It is typically diagnosed by a Gynecologist , Urogynecologist or a dermatologist with a biopsy.

Vulvar Lichen Sclerosus currently has no cure but it can be managed with ongoing treatment with medications, sex therapy and Pelvic floor Physical therapy. The most common medication I see being used in my patient population are corticosteroids like Clobetasol. Some women benefit from using vaginal moisturizers and hormone management to decrease the flare ups.The biggest struggle is lack of education around skin problems of the private parts leading to late diagnosis and years of discomfort for many vulva owners.

Pelvic Floor Physical Therapy for Lichen Sclerosus

Painful sex: The skin of the labia and vaginal opening become tight due to lichen Sclerosus and cause pain with penetration. Pelvic floor physical therapists can use manual therapy techniques to decrease the tightness and teach you how to manage that on your own. 

Pelvic floor muscles: Pelvic floor muscles are often involved when someone is experiencing pelvic pain or painful sex. Pelvic floor physical therapy can be a game-changer in identifying and treating your muscle problems. Working on pelvic muscle issues not only decreases pain but also prevents future problems with lichens Sclerosus flare- ups. If you are a person with vulvar Lichen Sclerosus it is very important that you start working with a skilled pelvic floor Physical therapist early on.

Break the pain-cycle: Pain over the vulvar region causes muscle spasms as a protective response. The muscle spasm intensifies the pain experienced with touch or pressure over the genital area. This vicious cycle often exacerbates pain and causes anxiety around any and all genital contact. Working with movement professionals like pelvic floor physical therapists breaks the chronic pain cycles.

Pelvic floor dysfunction: Pelvic muscle issues that arise with Lichen sclerosus are usually chronic and progressive. Pelvic muscle problems and difficulty with relaxing interferes with bladder and bowel emptying. Issues that start in the vagina slowly start to work their way to the rest of the pelvis. What starts as painful sex often leads to additional  bladder issues like urgency , frequency or pain. In some women we see constipation or incomplete emptying as a result of underlying pelvic muscle tightness. 

Musculoskeletal problems: Pelvic muscles attach to the tailbone, hip joints and pubic bone. These muscles influence core stability and lower back support. Ongoing pelvic muscle tightness leads to tailbone pain, low back pain and hip pain. Working with a pelvic floor physical Therapist can help you get ahead of all these preventable aches and pains.

If you or someone you know has Lichen sclerosus, let’s chat!



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