Chapter 4 – The Vagina and Vulva

Lichen sclerosus

Lichen sclerosus accounts for about 10 per cent of patients with vulval symptoms.(21) It affects skin anywhere on the body, but most commonly affects the genital area. The aetiology is unclear, but it is thought to be an autoimmune disorder. Lichen sclerosus can occur at any age; ten per cent of cases start in childhood and may be mistakenly diagnosed as sexual abuse.(21) It is more common in postmenopausal women.

Lichen sclerosus can be asymptomatic and the diagnosis is only made at the time of a vulval examination for an STI or cervical screening test.

It is important to recognise and treat lichen sclerosis for two reasons:

It is associated with squamous cell carcinoma of the vulva – lifetime risk of 2-6 per cent.(21)

If not treated, it can result in significant atrophy and distortion of the genital skin.

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