Itching down below isn’t always yeast. Vulvar itching is one of the main symptoms of lichen sclerosus. Lichen sclerosus (LSA) is a skin condition that affects the genital and anal areas but can occur on the upper body, breasts, and upper arms. This disorder is more common in women, most times occurring after menopause. It can occur as early as childhood, however.

The cause of lichen sclerosus is unknown but thought to be an autoimmune disorder. Hormones, heredity, and prior injury may play roles in the development of lichen.

The symptoms of lichen sclerosus include itching, discomfort, pain, a white appearance of the skin, patches on the skin that become thin and wrinkled, tears in the skin, scarring of the skin, bleeding and even blistering. It is important to have a skin biopsy to confirm the diagnosis of lichen sclerosus. Having LSA can increase the risk of developing skin cancer.

The main treatment for LSA of the vulva is topical steroids. We are seeing promising studies using platelet-rich plasma (PRP) and laser treatments for the treatment of LSA, as well. We have personally been using Mona Lisa touch and/or PRP injections in our practice with good results. Surgery is best avoided but can be considered in extreme cases.

Self-care of the area can be helpful during flares. Using a lubricant or emollient (such as petroleum jelly, A&D ointment, or Aquaphor) to the area can soothe symptoms. Cleanse the area very gently, avoid harsh soaps or over-cleaning. Oatmeal baths, sitz baths, cool compresses or ice packs can soothe itchy, irritated skin. Oral antihistamines can help with night-time itching.

The key is early detection and treatment to avoid scarring of the labia. Regular exams every 6-12 months are recommended.

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