Dr Philippa Kaye On Embarrassing Conditions
Dr Philippa Kaye throws light on some embarrassing, painful and confusing issues
Dr Philippa Kaye
Suzannah is in her early forties and had had her symptoms for a couple of years before she came to talk to me. She said that she often had thrush and had periods of itching with a vaginal discharge which tended to clear up with a course or two of over the counter thrush treatment.
So in the beginning she just thought her symptoms were due to thrush. But despite multiple courses of pessaries or tablets from the pharmacist she still had sore, often itchy genitals, though her discharge had returned to what is normal for her.
She had tried changing her soap, then stopped washing with soap altogether, had changed her washing powder, her knickers, started bubble bath, stopped using bubble bath but she was still sore.
Things had come to a head when she could no longer have sex without an extremely painful burning sensation in her vagina and the soreness seemed to be worse for days afterwards. She and her partner had tried lubricant but again it didn’t seem to help. Quite frankly she was fed up.
When is examination needed?
Our initial consultation was by phone, but I brought Suzannah in. She was up to date with her cervical screening but needed to be examined and if appropriate, swabs could be taken for infection testing.
On examining Suzannah it was clear that she had lichen sclerosus.
What is lichen sclerosus?
Lichen sclerosus is an inflammatory skin condition, and although it can occur anywhere on the body it is most common in females to occur on the genitals and around the anus.
What causes lichen sclerosus?
The cause of the condition is not fully understood but it may be autoimmune, where the body’s immune system mistakenly attacks itself.
What symptoms can be present?
Symptoms include itching, soreness or burning sensation and there are white patches seen on the vulva, which look shiny. The skin can crack and bleed and then heal repeatedly over time leading to scarring of the genitals, meaning that the entrance to the vagina can shrink (causing pain on sex). The clitoris may be hidden under scar tissue and if the skin around the anus is affected, shrinkage can cause pain on opening your bowels and constipation.
Is there effective treatment for lichen sclerosus?
Treatment involves avoiding soaps and irritants (we should all avoid these to wash genitals!) as well as using moisturisers. A barrier ointment like petroleum jelly on any patches can help with discomfort on urination.
Strong steroid creams or ointments such as Dermovate are prescribed, initially to be used daily for a few months, then twice weekly to keep the condition under control. If scarring has occurred around the entrance to the vagina this may make sex painful. Vaginal dilators can gradually increase your tolerance to sex.
It is extremely important that you check your vulva with a mirror. If any patch/red or thickened area develops and doesn’t improve after two weeks of steroid ointment, see your doctor. Lichen sclerosus is linked to a small increased risk of vulval cancer so you may need a biopsy.
Although there is no cure for lichen sclerosus, treatments are effective and when I followed up on Suzannah after a few months her symptoms had resolved. She had needed to use vaginal dilators to help her and her partner with penetrative sex, but in combination with lots of lubricants was able to have an active sex life again.
Intimate irritation – if it isn’t thrush, what could it be?
Thrush is rare before puberty and after menopause (unless you’re on HRT) due to the pH of the vagina but…
- Other infections can cause irritation and pain such as herpes.
- Skin conditions such as eczema or psoriasis can affect the vulva.
- After menopause, lack of oestrogen can cause atrophic vaginitis, which can also lead to vulval and vaginal irritation. It can be treated with topical oestrogen.
- Vulval and vaginal cancers are rare, but can cause itching and soreness. If you have concerns please get checked.
Advice given in this article and on the My Weekly website and magazines is not meant to replace personalised medical advice from your doctor. If you have any health concerns please see your doctor.
Article written on August 12, 2021; article reviewed and updated on January 16, 2025.
Each week we’ll ask Dr Philippa Kaye to talk about a prominent health issue, so look out for more articles in our health and wellbeing section in coming weeks. Read her advice on Back Pain, Skin Cancer, Allergies, Parkinson’s Disease, Shingles, Ovarian Cancer, Endometriosis, Long Covid and Ticks and Lyme Disease.
