Vulval Lichen Sclerosus: What You Need to Know

By Dr Alice Rudd, Dermatologist & Founder, Skindepth Dermatology

If you've been experiencing persistent vulval itch, discomfort, or changes to the skin in your genital area, you may be dealing with a condition called lichen sclerosus — and you're far from alone. Vulval lichen sclerosus (LS) is one of the most common conditions we see in our Vulval Clinic here at Skindepth Dermatology, and yet it remains one of the most underdiagnosed. Many women live with symptoms for years before receiving an accurate diagnosis.

What Is Vulval Lichen Sclerosus?

Lichen sclerosus is a chronic inflammatory skin condition that most commonly affects the vulva and perianal area in women. It can occur at any age — including in young girls and postmenopausal women — though it peaks around the time of menopause, suggesting hormonal factors play a role. The exact cause isn't fully understood, but it's thought to involve immune dysregulation, with a genetic predisposition in some individuals.

The hallmark symptoms include intense itch (often worse at night), vulval soreness, skin fragility, and pain during intercourse. Over time, the architecture of the vulva can change significantly — the skin becomes pale, thin, and shiny, the labia minora may shrink, and the clitoral hood can become fused. These structural changes are often irreversible if the condition is left untreated, which is why early diagnosis and consistent management are so important.

Why It Matters: The Risk of Squamous Cell Carcinoma

Beyond its impact on quality of life, lichen sclerosus carries a small but real increased risk of vulval squamous cell carcinoma (SCC) — approximately 4–5% of women with LS will develop this over their lifetime. This is one of the key reasons we recommend ongoing dermatological review, not just symptom management. Regular monitoring allows us to detect any concerning changes early.

How We Treat Lichen Sclerosus at Skindepth Dermatology

At Skindepth, Dr Anna Schauer and I manage vulval lichen sclerosus with a thorough, individualised approach. The cornerstone of treatment is potent topical corticosteroid therapy — typically an ultra-potent steroid is applied to the affected area. When used correctly and consistently, this can significantly reduce symptoms, halt architectural change, and lower the risk of malignant transformation.

We take the time to counsel each patient on exactly how to apply their treatment, for how long, and how to taper. Getting this right makes a significant difference to outcomes. We also address barrier function and vulval skin care more broadly — many patients benefit from switching to soap-free, fragrance-free cleansers and avoiding common irritants.

For patients who don't respond adequately to topical steroids, we explore second-line options including topical calcineurin inhibitors. We also work collaboratively with gynaecologists and pelvic floor physiotherapists where appropriate, recognising that LS can impact sexual function, pelvic pain, and mental wellbeing.

Our Vulval Clinic

Dr Anna Schauer and I are both passionate about this area of dermatology. Conditions affecting the vulva are frequently dismissed, misdiagnosed, or undertreated — and we believe every patient deserves a thorough, respectful, evidence-based assessment. Our Vulval Clinic is a safe and private space where these concerns can be addressed openly.

If you've been suffering in silence, please don't. A diagnosis of lichen sclerosus is very manageable with the right care. We're here to help.

To book an appointment at Skindepth Dermatology Perth, contact our clinic directly. Referrals from your GP are welcome.