Vulvar Lichen Planus

Vulvar lichen planus is a chronic skin condition that causes inflammation and rash on the vulva and vagina. Lichen planus can also affect other parts of the body, like your mouth, upper body, nails, and scalp.

Vulvar lichen planus is more common in perimenopausal and menopausal women (although it’s unclear why), and it’s a fairly misunderstood condition. Keep reading to learn more about the symptoms, causes, and treatments for vulvar lichen planus.

Symptoms of vulvar lichen planus

The biggest sign of vulvar lichen planus is a dry, itchy rash on the labia, clitoris or vaginal opening. Other symptoms of vulvar lichen planus are:

Dry, sore patches of skin on the vulva
Pain or burning around the vulva and/or vagina
Soreness, burning and itching around the vulva
Pain when having sex or peeing
Bleeding after sex
Abnormal vaginal discharge

In more severe cases, lichen planus can cause scarring that changes the appearance of the vulva. Lichen planus can make the labia minora smaller and flatter, the clitoris can merge with the clitoral hood, or cause parts of the vulva and vagina to fuse together.

What does vulvar lichen planus look like?

Lichen planus has three major subtypes, which can all affect the skin of the vulva in different ways.

Erosive lichen planus is the most severe form of LP. It causes painful ulcers on the vulva and vagina.
Papulosquamous lichen planus causes small, itchy papules.
Hypertrophic lichen planus causes dry, scaly skin patches.

There are many other skin conditions that can cause an itchy rash on the vulva, so lichen planus is often misdiagnosed for something else, like lichen sclerosus or eczema. Your doctor will perform a skin biopsy to properly diagnose lichen planus.

Can vulvar lichen planus cause complications?

Vulvar lichen planus isn’t a type of cancer, but it can increase the risk of developing vulvar cancer. This is very rare, though, and usually happens when the condition is left untreated.

Lichen planus can also affect your quality of life and make penetrative sex difficult, so sexual dysfunction can become a long-term complication.

Vulvar lichen planus causes

The exact cause of lichen planus isn’t known, but it’s thought to be an autoimmune disorder.

Normally, your immune system protects your body from infections and illness by producing antibodies, a type of protein that attacks pathogens (like viruses or bad bacteria). In lichen planus, your immune system instead attacks healthy skin, causing inflammation and the onset of symptoms.

Lichen planus can be triggered by:

A hepatitis C infection
Other autoimmune diseases
Stress and anxiety
OTC painkillers like non-steroidal anti-inflammatory drugs (NSAIDs)
Some medications for high blood pressure, diabetes, heart disease, and malaria.

Can I have sex if I have lichen planus?

Yes! Lichen planus isn’t an STI and you can’t spread it with sexual contact, so there’s no reason for you to abstain from sex — unless a specific sexual activity causes you pain and discomfort. Talk to your doctor if you find sex painful, whether because of lichen planus or any other reason!

How to treat vulvar lichen planus

Unfortunately, there is no way to get rid of lichen planus completely, so the best course of action is to try and manage the symptoms. There’s a lack of high-quality studies on vulvar lichen planus, but the most common treatments include:

Antihistamines to reduce itching.
Highly potent topical corticosteroid ointments applied to the vulva and vagina can provide relief and stop lichen planus from spreading.
Oral steroids can be used in cases of severe disease where topical application is not feasible.
Photodynamic therapy and ultrasound.
In the case of severe scarring, surgery can remove adhesions that cover the entrance to your vagina.
Vaginal dilators can also help.

Lifestyle and home remedies

There are also a few things you can do yourself to improve your symptoms:

Avoid using soaps, douches, or wipes on your vulva and vagina.
Wash your vulva with an emollient soap substitute to keep the skin moisturized (just using water can be too drying).
Avoid taking hot baths.
If you use period pads, opt for non-scented options.
Use a hypoallergenic moisturizer or emollient on your vulva.
Use body-safe lube to protect the skin around your vagina during sex.

TLDR

Vulvar lichen planus is a chronic skin condition that causes an itchy, painful rash on the vulva and vagina.
The cause is unknown, but it may be autoimmune in origin.
Lichen planus is not an STI, nor is it contagious, so it’s completely ok to have sex (as long as it’s not painful).
There’s no cure for vulvar lichen planus, but it can be managed with topical medications and lifestyle changes. In more severe cases, you might need surgery.

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