Understanding and treating lichen planus

When painful sores and erosions affect your vulvar and vaginal health, specialist care can help manage this complex condition

Lichen planus is an inflammatory condition that can affect the skin and mucous membranes, including the vulva and vagina, causing painful sores, erosions, and scarring.

If you’ve been experiencing persistent soreness, painful red areas, or erosions in the vulvar or vaginal area, you may have lichen planus. This condition can significantly impact your quality of life and requires specialist diagnosis and treatment to manage symptoms and prevent complications.

At The Women’s Health Vulvo-Vaginal & Genitourinary Clinic, we specialise in diagnosing and treating vulvovaginal lichen planus. Our team provides comprehensive care to help you find relief and prevent long-term complications.

Lichen planus is challenging, but with proper treatment, symptoms can be managed effectively. Let us help you find relief.

Do you have vulvovaginal lichen planus?

You may have lichen planus if you experience:

Painful red, inflamed areas on the vulva or in the vagina
Erosions or sores that don’t heal
Burning or stinging sensations
Painful intercourse due to inflammation or scarring
Vaginal discharge (often yellow or blood-tinged)
Bleeding after intercourse or examination
Scarring or narrowing of the vaginal opening
White, lacy patterns on the vulvar skin (in some cases)

If this sounds familiar, it’s important to seek specialist assessment.

Common types and causes

1. Erosive Lichen Planus

The most common and severe form affecting the vulva and vagina. It causes painful erosions, redness, and inflammation of the mucous membranes.

2. Classic Lichen Planus

Causes purple, flat-topped bumps and white, lacy patterns on the skin. This form is less common in the genital area but can occur.

3. Autoimmune Response

Lichen planus is believed to be an autoimmune condition where the immune system attacks the skin and mucous membranes. It’s more common in women with other autoimmune conditions.

4. Medication-Triggered

Certain medications can trigger lichen planus in susceptible individuals, though this is less common for the genital form.

5. Genetic Predisposition

There may be a genetic component, as lichen planus sometimes runs in families.

How we diagnose and treat lichen planus

Comprehensive history

We’ll discuss:

When symptoms started and how they’ve progressed
The nature and severity of your pain or discomfort
Impact on sexual function and daily activities
Previous treatments and their effectiveness
Medical history, including other autoimmune conditions
Medications you’re currently taking

Thorough examination

A careful examination will reveal:

Areas of redness, inflammation, or erosion
White, lacy patterns (if present)
Scarring or architectural changes
Extent of vaginal involvement
Signs of secondary infection

Biopsy for confirmation

A small tissue biopsy is usually necessary to confirm the diagnosis and rule out other conditions with similar appearances.

Treatment approach

Treatment for lichen planus may include:

Topical corticosteroids
Systemic medications
Topical calcineurin inhibitors
Symptom management
Vaginal dilators
Ongoing monitoring

Frequently asked questions

Q: Is lichen planus curable?

A: Lichen planus is a chronic condition without a cure, but symptoms can be managed effectively with proper treatment. Some women experience periods of remission, whilst others require ongoing treatment.

Q: Will lichen planus cause permanent damage?

A: Without treatment, lichen planus can cause scarring and narrowing of the vagina. Early diagnosis and treatment can help prevent these complications.

Q: Is lichen planus contagious or sexually transmitted?

A: No, lichen planus is not contagious and cannot be transmitted through sexual contact. It is an autoimmune condition.

Q: Can I still have sex with lichen planus?

A: Sexual activity may be painful during active disease, but with proper treatment and use of lubricants, many women can return to comfortable intimacy. Vaginal dilators may help maintain vaginal capacity.

Q: How is lichen planus different from lichen sclerosus?

A: Whilst both are inflammatory conditions, they have different appearances and treatments. Lichen planus typically causes erosions and affects mucous membranes, whilst lichen sclerosus causes white, atrophic skin changes. A biopsy can distinguish between them.

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Take the first step towards effective management

Lichen planus requires specialist care and ongoing management, but with proper treatment, you can control your symptoms and prevent complications. Early intervention is key.