Aesthetic Gynecology
Agnieszka Mikucka, MD, PhD
Clinic/Diagnostics
Diagnostics · chronic inflammatory diseases of the vulva

Lichen sclerosus
and lichen planus of the vulva.

Changes in the intimate area can cause discomfort, pain, itching and a great deal of worry. It is worth remembering that they are nothing to be ashamed of — they are a health problem that can be diagnosed and treated effectively. An early consultation helps limit the progression of lesions, reduce symptoms and improve everyday comfort.

Learn about both conditions
2 conditionsvulvar lichen sclerosus · lichen planus
history and examinationthe basis of diagnosis, with a biopsy when needed
confidentiala consultation that respects your comfort and boundaries
A word of introduction

Changes in the intimate area
are nothing to be ashamed of.

Changes in the intimate area can cause discomfort, pain, itching and a great deal of worry. It is worth remembering that they are nothing to be ashamed of — they are a health problem that can be diagnosed and treated effectively.

An early consultation helps limit the progression of lesions, reduce symptoms and improve everyday comfort. Below you will find the most important information about two chronic inflammatory diseases: lichen sclerosus and lichen planus — as well as the gynaecological ultrasound performed at the practice.

I.

Lichen sclerosus

A chronic inflammatory disease of the skin and mucous membranes that most often affects the vulva and the perianal area.

Go to sectionII.

Lichen planus

A chronic, non-contagious inflammatory disease that can involve the skin, mucous membranes, nails, and the vulva and vagina.

Go to sectionIII.

Gynaecological ultrasound

A painless, non-invasive imaging examination of the uterus, endometrium and ovaries — as prevention and when symptoms appear.

Go to section
Condition I · lichen sclerosus

Lichen
sclerosus.

Lichen sclerosus is a chronic inflammatory disease of the skin and mucous membranes that most often affects the vulva and the perianal area. It is more common in women and can appear both in girls before puberty and in women around the menopause.

The exact cause of the disease is not fully understood. Immunological, genetic and hormonal factors are believed to play a role in its development. Lichen sclerosus is sometimes associated with other autoimmune conditions such as Hashimoto’s disease, vitiligo, psoriasis, atopic dermatitis or rheumatoid arthritis.

The disease is chronic and relapsing — periods of flare-ups may alternate with remission. Properly managed treatment helps calm the inflammation, limit scarring and extend the time free of symptoms.

Symptoms

Symptoms may develop gradually
and vary in severity.

The most common include:

  • itching, burning or a feeling of irritation in the intimate area

  • dryness, tightness of the skin and discomfort when sitting or being active

  • pale patches, small papules or a change in skin texture

  • painful fissures, erosions, petechiae or tenderness

  • pain during intercourse

  • a gradual loss of tissue elasticity

  • scarring and changes in the anatomy of the vulva

Not every patient experiences all of these symptoms. Some women feel only itching or recurrent irritation for a long time, which is often mistaken for an intimate infection.

Diagnostics

History, examination and — when needed — a biopsy.

Diagnosis is based primarily on a thorough medical history and physical examination. In some cases the doctor may recommend taking a small sample of the affected tissue for histopathological examination. This confirms the diagnosis, rules out other causes of the lesions and helps choose the right treatment.

Regular check-ups are also important because chronic, untreated lesions require oncological surveillance. The risk of developing squamous cell carcinoma is low, but it calls for vigilance and medical follow-up.

Treatment

Topical preparations selected individually.

Treatment is usually based on topical preparations selected individually according to the severity of the lesions. They may include, among others:

  • ✦

    topical anti-inflammatory medicines, including glucocorticosteroids

  • ✦

    calcineurin inhibitors

  • ✦

    selected retinoid preparations

  • ✦

    skincare that supports the protective barrier of the skin and mucous membranes

In selected cases treatment can be extended with modern methods that support tissue regeneration and improve elasticity. These include platelet-rich plasma, fractional laser, radiofrequency, hyaluronic acid preparations and oxygen therapy. The choice of therapy should always follow from the current picture of the disease, the severity of symptoms and the individual needs of the patient.

Condition II · lichen planus

Lichen
planus.

Lichen planus is a chronic, non-contagious inflammatory disease that can involve the skin, mucous membranes, nails and the scalp. In women it can also affect the vulva and vagina.

It is most often diagnosed in adults, usually between the ages of 30 and 60. The cause of the disease has not been clearly established. In some patients it coexists with other autoimmune or chronic conditions, including vitiligo, alopecia areata, lupus erythematosus, systemic sclerosis, diabetes or inflammatory bowel disease.

Flare-ups can be triggered by stress, certain medicines and — in the case of oral lesions — contact factors such as amalgam fillings. Lichen planus can be relapsing, which is why it requires regular follow-up and consistent treatment.

Symptoms in the intimate area

See a doctor
at the first worrying symptoms.

Vulvar lichen planus can cause considerable discomfort, yet many women put off a consultation for a long time out of fear of the examination or embarrassment. Symptoms may include:

  • burning, pain, itching or tenderness of the vulva

  • redness and hypersensitivity of the mucous membranes

  • erosions, ulcerations or painful fissures

  • contact spotting and a feeling of dryness

  • pain during intercourse

  • scarring, adhesions and gradual narrowing of the vaginal opening

  • recurrent bacterial or fungal infections

Vulvar lesions may coexist with lesions in the mouth. During the consultation it is therefore worth mentioning any burning, soreness, erosions or whitish changes on the lining of the cheeks, tongue or gums.

Diagnostics

Clinical picture, examination and — when needed — a biopsy.

The diagnosis is made on the basis of the clinical picture and a medical examination. When necessary, a tissue sample is taken for histopathological examination. This is important because the symptoms of lichen planus can resemble other inflammatory diseases, infections or lesions that require a different approach.

Regular check-ups are an important part of care, because chronic inflammatory lesions require monitoring and, in rare cases, may carry a risk of developing squamous cell carcinoma.

Treatment

Tailored to the location and activity of the lesions.

Treatment is selected individually and depends on the location of the lesions, their activity and the severity of symptoms. The most commonly used are:

  • ✦

    topical anti-inflammatory medicines, including glucocorticosteroids

  • ✦

    retinoid preparations

  • ✦

    antihistamines, if the itching is severe

  • ✦

    treatment of coexisting infections

  • ✦

    appropriately chosen care for the delicate intimate area

In justified cases, therapy can be supplemented with methods that support healing and tissue regeneration, such as photodynamic therapy, radiofrequency, platelet-rich plasma, oxygen therapy or non-ablative fractional laser.

Surgical treatment is considered only in specific situations, e.g. with significant adhesions or scarring. It should be carried out during remission, after the inflammation has been calmed.

Examination · ultrasonography

Gynaecological
ultrasound.

A gynaecological ultrasound is a painless, non-invasive imaging examination that assesses the pelvic organs — the uterus, the endometrium and the ovaries. It is a basic element of gynaecological prevention and diagnostics.

The scan is most often performed with a transvaginal probe, which gives the most detailed image; in selected situations it is done through the abdominal wall. It usually takes around fifteen minutes, needs no special preparation, and the result is discussed straight away, during the same visit.

Ultrasound complements the medical history and the gynaecological examination — it helps explain the cause of symptoms, assess any findings and plan further care or follow-up.

When it is worth having

As prevention and when symptoms appear.

  • ✦

    as part of a regular gynaecological check-up

  • ✦

    with irregular, heavy or painful periods and spotting

  • ✦

    with lower abdominal pain or discomfort during intercourse

  • ✦

    to assess cysts, fibroids, polyps and endometrial thickness

  • ✦

    before a planned procedure and as follow-up after treatment

What to expect

About fifteen minutes, no preparation.

The scan is done on the gynaecological chair and is painless. You do not need to fast or prepare in any special way — before a transvaginal scan it is simply best to empty your bladder.

The image is discussed as we go, and you receive the written report on the spot. The ultrasound can be combined with a gynaecological consultation in a single visit.

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You don’t have to wait to be seen

Itching, burning, pain —
should not be dismissed.

Itching, burning, pain during intercourse, recurrent irritation or a change in the appearance of the skin in the intimate area should not be dismissed. They do not always mean an infection — they may be a symptom of a chronic inflammatory disease that requires a different treatment.

The consultation takes place with respect for the patient’s privacy, comfort and boundaries. The aim of the visit is not only to make a diagnosis, but above all to reduce symptoms, protect the tissues from scarring and restore comfort in everyday life and intimacy.

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