Vulval Lichen Planus: Symptoms, Causes, and Treatment in the UK

Vulval lichen planus is a chronic inflammatory condition that affects the mucous membranes of the vulva and often the vagina. Unlike common infections, it is an autoimmune-mediated disorder where the body's immune system mistakenly attacks the skin cells in the genital area. In the UK, it is less common than lichen sclerosus but can be significantly more distressing due to its tendency to cause erosive (open) sores.

While the exact cause remains unknown, it is not contagious and cannot be passed on through sexual contact. It is most frequently diagnosed in women aged 40 to 60, though it can occur at any age. According to NHS guidance, effective management is key to preventing the progression of the disease and maintaining quality of life.

The symptoms of vulval lichen planus can vary between individuals but generally fall into three patterns: erosive, papular, or hypertrophic. The most common form in the UK is the erosive type.

• Soreness and Rawness: The skin may look bright red and feel extremely tender, similar to a graze.
• White Patches: You may notice fine, white, lacy patterns (known as Wickham striae) on the labia or around the clitoris.
• Vaginal Discharge: If the internal lining of the vagina is involved, you may experience a yellow or blood-stained discharge.
• Painful Intercourse: Inflammation and potential scarring can make sexual activity very painful (dyspareunia).
• Itching and Burning: A persistent, distressing itch that does not respond to over-the-counter thrush treatments.

Diagnosis usually begins with a physical examination by a GP or a specialist at a sexual health clinic. Because the symptoms can overlap with other conditions such as bacterial vaginosis, vulval thrush, or lichen sclerosus, a definitive diagnosis is crucial. NICE (National Institute for Health and Care Excellence) guidelines often suggest that a skin biopsy may be required for a confirmed diagnosis, where a tiny sample of skin is taken under local anaesthetic for laboratory analysis.

Early intervention is vital. If left untreated, the inflammation can lead to the 'fusing' or narrowing of the labia and the vaginal opening, which can be difficult to reverse without surgical intervention.

While there is currently no permanent cure for lichen planus, symptoms can be effectively managed with the right medical approach. The primary goal of treatment is to reduce inflammation and prevent scarring.

Topical Steroids

The first line of treatment is typically a very potent topical steroid cream or ointment, such as clobetasol propionate. Unlike mild steroids used for eczema, the skin of the vulva in this condition requires stronger medication to calm the immune response. Your doctor will provide a specific tapering schedule for application.

Emollients

Using soap substitutes and bland emollients is essential. The NHS recommends avoiding scented soaps, bubble baths, and feminine wipes, as these can further irritate the delicate skin barrier.

Vaginal Dilators

If the vagina is affected and narrowing has occurred, a GP or specialist may recommend the use of vaginal dilators to help maintain the flexibility of the vaginal walls and reduce pain during future intercourse.

Many women feel hesitant to discuss genital skin concerns, but seeking professional advice is the best way to find relief. You should consider booking a consultation with an online doctor in the UK if you have persistent vulval itching, unexplained redness, or pain that makes daily activities or intimacy difficult.

An online GP can provide a confidential environment to discuss your symptoms, review your medical history, and advise on whether your symptoms are consistent with lichen planus. They can also provide private prescriptions for high-potency treatments or refer you to a local dermatologist or gynaecologist for a biopsy if required. Speaking to a GP online allows you to start the diagnostic process from the comfort and privacy of your home.

Alongside medical treatment, certain lifestyle adjustments can help manage flares of vulval lichen planus:

• Wear loose-fitting cotton underwear to allow the area to breathe.
• Avoid tight trousers or leggings that cause friction.
• Use a barrier ointment (like plain Vaseline) before swimming in chlorinated water.
• Gently pat the area dry after washing rather than rubbing.
• Consider using a water-based lubricant during sexual activity to reduce irritation.