Lichen sclerosus is a medical condition that causes itchy white patches of skin, normally in the genital and anal areas of the body. An autoimmune disorder, lichen sclerosus generally affects girls who have not yet gotten their periods or postmenopausal women. It can, however, affect women of all ages.

When this condition affects the vulva, it can cause flattening of the labia minora, vulvar atrophy, and vulvar adhesions, meaning that parts of the labia become stuck together. It can also cause clitoral phimosis, which is when the retractable fold of skin that covers the clitoris (the clitoral hood) becomes inflamed and adheres to the clitoris. Other common symptoms of vulvar lichen sclerosus are burning, itching, scarring, inflammation, and narrowing of the vagina.

Given these symptoms, perhaps it is not surprising that many women with lichen sclerosus experience female sexual dysfunctions such as dyspareunia (pain during intercourse), difficulties with orgasm, and reduced sexual frequency. What’s more, the standard treatment for lichen sclerosus of topical steroids may have undesirable sexual side effects for women when used long term. Currently, there is no cure for lichen sclerosus, so treatments are aimed at lessening symptoms and hopefully prompting remission.

Since the association between lichen sclerosus and sexual dysfunction has been relatively understudied, a team of researchers decided to conduct a systematic review and meta-analysis of the existing research on the topic. Their goal was to determine the prevalence of sexual dysfunction in women with vulvar lichen sclerosus.

After a methodical search of the PubMed database, they identified 23 studies that met their inclusion criteria. Ultimately, they were only able to use five studies to calculate the prevalence of sexual dysfunction in women with vulvar lichen sclerosus because the other publications did not present raw data, were focused on the surgical management of severe lichen sclerosus, or did not clearly define sexual dysfunction. Therefore, there was a total of 486 participants with lichen sclerosus across these five studies.

Of the 486 women with lichen sclerosus, 208 (or 59%) were experiencing some form of female sexual dysfunction. Since a large proportion of women with vulvar lichen sclerosus experience sexual dysfunction, it is important for them to feel empowered to seek help in this arena. Whether they are displeased with the appearance of their genitals, distressed about experiencing pain during intercourse, or feel less satisfied with their sexual experiences, sexual medicine providers and sex therapists can help.

References:

• Pope, R., Lee, M.H., Myers, A., Song, J., Abou Ghayda, R., Kim, J.Y., Hong, S.H., Lee, S.B., Koyanagi, A., Jacob, L., Smith, L., & Shin, J. I. (2022). Lichen sclerosus and sexual dysfunction: a systematic review and meta-analysis. The Journal of Sexual Medicine, 19(11), 1616-1624. DOI: https://doi.org/10.1016/j.jsxm.2022.07.011