Vaginal and vulvar skin diseases are poorly covered in medical school, and during residency it often comes down to the number of patients you see. If you practiced in an area with a higher incidence—whether due to environment, genetics, or ethnicity—you probably became very familiar with diagnosing vulvar and vaginal conditions.

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My first case of lichen sclerosus was during residency, and it had such a profound effect on me. She started her story with:

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• “I am tearing with intercourse.”
  
  
• “When I wipe, I feel like my skin just burns.”
  
  
• “The skin folds are disappearing.”
  
  
• “No, I haven’t looked—I’m too afraid.”
  
  
• “It’s itchy but without any discharge.”
  
  
• “I have never had problems like this before.”
  
  

Here’s the thing: I had heard this many times before. I assumed it was a terrible yeast infection or postmenopausal changes. I nodded, thinking in my head, I know what this is.

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But when I started the exam, my first thought was: this definitely isn’t normal. OMG — how long had she been suffering? Where had I seen this before?

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Thankfully, behind every good physician are good teachers. Within 30 seconds, my attending said: lichen sclerosus.

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What Is Lichen Sclerosus?

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Lichen sclerosus (LS) is an inflammatory skin disease of the vulva, often considered autoimmune in nature. It typically begins with itching and irritation, but as it progresses, the skin becomes thin, white, and fragile. This loss of elasticity makes the tissue prone to tearing, which explains why wiping and intercourse become painful.

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Why Early Diagnosis Matters

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Here’s the thing about LS: if not caught early, it can cause permanent scarring. In severe cases, patients may lose the labia minora or clitoral hood as the skin breaks down and scars. Treatments like topical steroids can relieve symptoms and stop progression, but once there are severe architectural changes, those may not be reversible.

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Even more concerning, lichen sclerosus increases the risk of vulvar squamous cell carcinoma if left untreated or not monitored over time.

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Our Commitment to Vaginal Health

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This is why we developed our dedicated vaginal clinic at Gliss — to provide care for patients facing long waiting times or living in areas without access to expert providers. With earlier diagnosis and proper treatment, women with lichen sclerosus can find relief, protect their vaginal health, and prevent long-term complications.

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Book a 15-min FREE virtual consultation with us to see if we’re the right fit for your menopause care.

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And don’t forget to visit our Services page to explore our perimenopause and menopause care packages!