Vulvar surgery might alleviate sexual pain in women with lichen sclerosus (LS), but preoperative sexual counseling is important, according to a new Journal of Sexual Medicine study.

Lichen sclerosis is a skin condition that can affect the genital and anal areas of both men and women.

Common symptoms include:

• white patches on the skin,
• itching,
• burning sensations,
• bleeding,
• discomfort,
• and pain.

In women, LS can lead to changes in vulvar anatomy. The vagina can narrow, and the epithelium – the layer of tissue that lines the vagina – can become thin and develop fissures (tears), especially during intercourse.

As a result, penetration is often painful for women with LS. A narrow vagina may not be able to accept a penis comfortably and friction from thrusting can aggravate fissures and cause them to bleed. Some women stop having intercourse altogether.

Treatment

• One treatment for LS is the application of a topical corticosteroid, but this approach doesn’t always help sexual symptoms.
• Vulvar surgery is another option.

Study on Vulvar surgery

• In this study, researchers from the Netherlands conducted interviews with LS patients to learn more about their sexual function after surgery for LS.
• Nineteen women participated. Their ages ranged from 30 to 72 years, with an average of 56. Most of the women had been in a long term relationship for many years. The interviews occurred from ten months to approximately five years after surgery.
• While 95% of the women felt that their day-to-day symptoms (not pertaining to sex) had improved, approximately two-thirds reported decreased sexual pain.
• Fourteen women were able to have intercourse after surgery. Of these, four could do so with no pain at all. One woman said that her pain had not changed, but she continued to have intercourse anyway. For the rest of the group, pain had lessened to a “discomfort” level, which could vary in degrees depending on the sexual situation. Some women were pain-free for a while, but eventually started feeling pain again.
• Common threads in the interviews with these women included a reduced fear of pain, use of strategies for lessening discomfort during intercourse (such as a lubricant), more frequent sex, improved intimacy, and feeling more feminine and confident.
• Five women did not resume intercourse. Four of them were unable to talk to their partner about sexual matters, and they could not adapt their sexual routines to include non-penetrative activities. However, one woman and her partner attended sex therapy and were able to make adjustments.
• Two women who could not have intercourse also had medical conditions that could contribute to sexual pain: vaginismus (involuntary muscle spasms that, in some cases, prevent penetration) and unprovoked vulvodynia (chronic pain in the vulva).

The authors recommended that healthcare providers consult with couples before a woman has vulvar surgery for LS. They explained that knowing more about a couple’s sex life, communication skills, and willingness to make adjustments is important, as is addressing other medical factors that can cause pain.

“This information and checking for contraindications mentioned earlier would be necessary to estimate whether a woman with LS with a wish for vulvar surgery would benefit from it and/or whether she would be a candidate for additional sexual counseling pre- and/or postoperatively,” they wrote.

Resources

• The Journal of Sexual Medicine - “A Qualitative Study on Experiences After Vulvar Surgery in Women With Lichen Sclerosus and Sexual Pain”
  Brauer, Marieke, PhD, et al.
  (Full-text. Published online: May 18, 2016)
  http://www.jsm.jsexmed.org/article/S1743-6095(16)30174-6/fulltext

• Mayo Clinic - “Lichen sclerosus”
  (September 3, 2015)
  http://www.mayoclinic.org/diseases-conditions/lichen-sclerosus/basics/definition/con-20028610