Article by Dr. Patricia Gutiérrez Ontalvilla, MD, PhD. Plastic surgeon, doctor of medicine, specialist in vulvar lichen sclerosus and creator of the Liquenia® Protocol.
There is a question that almost no patient asks and that I have learned to ask myself: how much time a day do you spend thinking about that area? The answer is usually “all the time.” And it usually comes with surprise, because no one had asked them before. Constant vulvar itching occupies much more space than most women allow themselves to acknowledge out loud.
The constant vulvar itching that you notice even when still, sitting, and without touching anything has an explanation in the skin, not in the head. Skin that has been inflamed for years needs less stimulus to send a signal than healthy skin. In vulvar lichen sclerosus, that permanent signal is often the first real reason to look at the skin instead of continuing to treat infections that never fully heal.
Is it normal to feel the vulva without anything touching it?
I explain it this way in the clinic. Healthy skin alerts you when something touches it. Skin that is chronically inflamed lowers its threshold and alerts you even when nothing is happening. A stimulus is no longer needed for the area to manifest itself. This is why many women describe discomfort while sitting still, on the sofa, or in bed.
That is not an obsession or hypochondria. It is skin sensitized by inflammation that has been active for a long time. And it has a practical consequence: constant vulvar itching pushes one to scratch, scratching breaks the barrier, and the break causes further inflammation. The circle sustains itself, especially in the early hours of the morning, when there is nothing to distract the attention.
This point is described in the literature. Sadownik, Koert, Maher, and Smith documented it in The Journal of Sexual Medicine in 2020. Women with chronic vulvar dermatoses described their symptoms as something that occupies everything. They interfered with thought and daily activity. It is worth noting the type of study: in-depth interviews with twelve women, without a comparison group. It does not measure frequency or allow for the calculation of percentages. It serves to name the experience of constant vulvar itching, not to quantify it.
Thinking about it all day is not a character trait: it has been measured
When a patient tells me she thinks about that area at all hours, she is not exaggerating. Wijaya, Lee, and Fischer evaluated in the Australasian Journal of Dermatology (2021) the quality of life of 68 women with as-yet-untreated vulvar lichen sclerosus, using a validated index specific to vulvar pathology. The domains with the highest scores were symptoms, sexuality, anxiety, and activities of daily living.
That same study provides the data I most want you to take away. The median duration of symptoms before diagnosis was 24 months. And 53% of the participants already had scarring when they were finally diagnosed. It is a cross-sectional study, in a single center in Sydney and with 68 patients. It describes a clinical reality well. It does not allow that percentage to be applied to your specific case or predict what will happen to you.
The fact that the constant vulvar itching is continuous does not mean that the disease is out of control or that you have done something wrong. It means that the skin has been sensitized for a long time. It is useful information for your specialist, not a reason to be frightened.
Why this signal is so often confused with yeast infections
Vulvar lichen sclerosus is diagnosed late for a specific reason: it looks like almost everything else. Like recurrent candidiasis, menopausal dryness, or irritation from soap. And constant vulvar itching is precisely the symptom that overlaps most with those conditions.
The numbers confirm it. Krapf, Smith, Cigna, and Goldstein published in the Journal of Lower Genital Tract Disease (2022) a cross-sectional study with 503 premenopausal women with biopsy-confirmed lichen sclerosus. The average delay between the onset of symptoms and diagnosis was 4 years. 66% had previously received another diagnosis, and in approximately half of those cases, it was a yeast infection. It is an online survey with voluntary participation, so it may overrepresent women with a worse clinical journey; even so, the pattern is too consistent to ignore.
The difference is not in the isolated symptom, but in the pattern that accompanies it. Constant vulvar itching can appear in several different conditions. Candidiasis responds to antifungals and goes away. Menopausal atrophy improves with local estrogen. Lichen sclerosus persists, has a marked nocturnal component, and does something the others do not: it modifies the anatomy. You can review the differences in detail on the differential diagnosis of lichen sclerosus page and the full picture in symptoms of vulvar lichen sclerosus.
What time changes: inflammation versus scarring
Here is the part that determines the prognosis and that almost no one explains in the clinic. Inflammation is treatable at any point in its evolution. Scarring, once established, does not reverse with cream. Labia minora that flatten, the clitoral hood that fuses over itself, the opening that narrows: these changes are no longer undone with a topical treatment.
That is why the time to diagnosis carries more weight here than in almost any other vulvar pathology. Constant vulvar itching that lasts for months is not just discomfort: it is time of accumulated inflammation. And that is why that 53% of women who already arrive at diagnosis with scarring seems to me the most uncomfortable figure in all recent literature.
Stopping inflammation is always worth it, even when there are already established changes. It protects the remaining tissue and prevents the condition from progressing further.
Dr. Patricia Gutiérrez Ontalvilla
The two errors: doing too much and doing too little
When I explain that the skin is sensitized, some patients conclude the opposite of what I intend: that it is best not to apply anything. It is the more costly error of the two.
Excess exists, of course. Applying potent corticosteroids daily and indefinitely, without a schedule or review, is not treating: it is improvising. But doing too little is the problem I see most frequently. Women who reduce the dose on their own, who space out the application because they feel better, or who abandon treatment out of fear. The inflammation continues to work in silence and the tissue pays the bill years later. You have the available options and their guidelines on the vulvar lichen sclerosus treatments page.
Constant vulvar itching that improves is not permission to stop treatment. It is the signal that the treatment is working.
When the disease remains active despite correct treatment
There is a subgroup of women in whom correctly prescribed corticosteroids fail to control the disease. For them, we research the Liquenia-SVF protocol, which combines nanofat and stromal vascular fraction obtained from the patient’s own fat.
We published the results in the Aesthetic Surgery Journal in 2025. 18 women with moderate or severe vulvar lichen sclerosus participated, treated in a single session. The itching score on the 5D scale dropped from 6.82 to 2.35 at 12 months. Quality of life measured with Skindex-29 went from 42.88 to 24.82. Biopsies at the same time showed less stromal hyalinization and less CD3+ T-lymphocyte infiltrate.
Now for the fine print, which is what really matters. It is a prospective, open-label, single-arm study with 18 patients and no control group: it describes what happened in those women, it does not prove causality against another alternative. Furthermore, in the study itself, low-dose corticosteroids were maintained throughout the follow-up, so the protocol should be understood as a complementary approach that enhances conventional treatment, not as a substitute. And a precision I always repeat: no published data allows for attributing a reduction in oncological risk to regenerative approaches. It has not been studied.
Regarding the correction of already established anatomical changes, that is also not what this study measured. When appropriate, that is a different surgical approach.
Signals that should not wait for the next review
Regardless of your level of itching, seek assessment without waiting if any of these situations appear:
- An ulcer or a wound that does not heal in two weeks.
- A lump, a thickened area, or a plaque that feels different from the rest.
- Vulvar bleeding without an explanatory cause.
- A reddish, dark, or changing color area that persists.
- New pain, always localized at the same point.
None of these mean on their own that something serious is happening. They mean that the skin must be looked at sooner, not later.
Frequently asked questions
Is it normal to notice constant vulvar itching even if I don’t touch anything?
Yes, it is common in vulvar lichen sclerosus. Skin that has been inflamed for years reduces its threshold and sends a signal without the need for external stimulus. This is why many women notice discomfort while sitting still or lying down. It is not a problem of nerves or imagination: it is sensitized skin that should be evaluated by a specialist.
Does constant vulvar itching mean that the lichen sclerosus is getting worse?
Not necessarily. Constant vulvar itching indicates that the skin remains sensitized, which is not equivalent to disease progression. Evolution is assessed by looking at the skin and its anatomy, not just by the intensity of the symptom. If the itching pattern changes, is always localized in one spot, or a wound appears, seek assessment.
Could it be recurrent candidiasis instead of lichen sclerosus?
It could be, and in fact, it is the most common confusion. In the study by Krapf and colleagues (2022) with 503 women, 66% previously received another diagnosis, and in about half, it was a yeast infection. The key difference: candidiasis responds to antifungals and disappears, while lichen sclerosus persists and modifies the anatomy.
If I already have changes in anatomy, is there any point in treatment?
Yes. Established anatomical changes do not reverse with cream, but stopping the inflammation prevents them from progressing, improves symptoms, and protects the remaining tissue. The fact that there is already scarring is not a final point: it is a reason not to wait any longer. The correction of those changes, when appropriate, corresponds to a different surgical approach.
Does regenerative treatment eliminate itching forever?
That is not what has been studied. In our work published in the Aesthetic Surgery Journal (2025), 18 women showed improvement in itching maintained at 12 months after one session, with less fibrosis on biopsy. It is an open-label study without a control group, and low-dose corticosteroids were maintained during follow-up.
Have you been treating something for years that never fully heals?
Vulvar lichen sclerosus is diagnosed by looking at the skin. If you have recognized yourself in this article, the next step is an in-person assessment, not a private message.
References
- Wijaya M, Lee G, Fischer G. Quality of life of women with untreated vulval lichen sclerosus assessed with vulval quality of life index (VQLI). Australasian Journal of Dermatology. 2021;62(2):177-182. https://doi.org/10.1111/ajd.13530
- Krapf JM, Smith AB, Cigna ST, Goldstein AT. Presenting Symptoms and Diagnosis of Vulvar Lichen Sclerosus in Premenopausal Women: A Cross-Sectional Study. Journal of Lower Genital Tract Disease. 2022;26(3):271-275. https://doi.org/10.1097/LGT.0000000000000679
- Sadownik LA, Koert E, Maher C, Smith KB. A Qualitative Exploration of Women’s Experiences of Living With Chronic Vulvar Dermatoses. The Journal of Sexual Medicine. 2020;17(9):1740-1750. https://doi.org/10.1016/j.jsxm.2020.06.016
- Gutiérrez-Ontalvilla P, Gómez Rojas A, Iborra Colomino M, Canikyan S, Kul Y, Duyan C, Codoñer P. Clinical and Histopathological Investigation of Stromal Vascular Fraction and Nanofat in Vulvar Lichen Sclerosus. Aesthetic Surgery Journal. 2025;45(11):1166-1174. https://doi.org/10.1093/asj/sjaf148
Dr. Patricia Gutiérrez Ontalvilla, MD, PhD. Doctor of medicine, plastic surgeon, and scientific researcher specialized in lichen sclerosus and regenerative cells. President of the Nixarian Foundation and creator of the Liquenia® Protocol. More professional information at dragutierrez.com.
This article is for informational purposes and does not replace an individual medical assessment. Vulvar lichen sclerosus is a chronic condition that requires diagnosis and follow-up by a professional. Individual cases are not assessed via private message or email.
