Which patient history features should raise suspicion for vulvar lichen sclerosus?
Vulvar lichen sclerosus has a few telltale patterns in a person’s history that can help raise suspicion, especially when symptoms keep going despite the usual menopause care.
Here at Alloy, we see it most often in midlife and postmenopause, and the context you shared lines up with that. Women with lichen sclerosus often describe itching that is intense and persistent, sometimes worse at night. They may also mention cracking or bleeding of the vulvar or perianal skin, which is different from the dryness and irritation that comes with genitourinary syndrome of menopause. Another feature is the gradual loss or shrinking of the labia minora or changes in the clitoral area, which happens because the condition causes scarring. This can happen so slowly that people sometimes think it is just part of aging.
A history of an autoimmune condition can also be a clue, because lichen sclerosus is thought to have an autoimmune component. And if someone has been using vaginal estrogen correctly but still has ongoing severe itching on the vulva itself, that is another moment to think about lichen sclerosus and get a careful vulvar exam.
If you want a great visual explanation, Dr. Rachel Rubin walks through the skin changes and symptoms in her menopause vaginal health video. The section on lichen sclerosus is here through our chapter link: Lichen Sclerosus & Vulvar Conditions.
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