Sexuality and vulvar lichen sclerosus
VLS can profoundly affect one’s sexual life. In my practice, I discuss this with all my patients—because silence on this subject helps no one.
Why VLS affects sexual life
Dyspareunia—pain during sexual intercourse—is one of the most prevalent symptoms of VLS and one of those with the greatest impact on quality of life. The causes are multiple and cumulative:
Fragility of the vulvar tissue. Atrophy and the loss of elasticity in the vulvar tissue mean that any contact or distension causes pain or a tearing sensation.
Narrowing of the introitus. Progressive fibrosis can reduce the vaginal opening, making penetrative intercourse painful or impossible.
Vulvar dryness. The alteration of the skin barrier reduces natural lubrication, increasing friction and pain.
Reflex pain and muscle tension. Chronic pain in the vulvar area can cause tension in the pelvic floor muscles—a cycle that amplifies pain during intercourse.
The emotional component. Fear of pain, shame regarding the condition, and the impact on self-esteem can cause sexual desire to decrease as a secondary result of physical pain.
Strategies to regain a satisfying sexual life
Control of the active disease
The starting point is controlling the disease. Dyspareunia improves significantly when VLS is well-managed with the correct treatment. If inflammatory activity decreases, the tissue partially recovers and tolerance to contact improves.
Adequate lubrication
The use of high-quality lubricants during sexual intercourse is essential for many patients with VLS. Selection criteria: fragrance-free, glycerin-free (as it can promote yeast infections), water-based or silicone-based. Oil-based lubricants are not compatible with latex condoms.
Pelvic floor rehabilitation
When there is tension in the pelvic floor muscles—a consequence of chronic pain and the fear of pain—pelvic floor physiotherapy can be of great help. A specialized physiotherapist can address muscle hypertonia and significantly improve tolerance to penetration.
Communication with your partner
Sexuality with VLS requires adapting rhythms and practices to the patient's situation. This adaptation is only possible through open communication with one's partner. In my practice, I recommend that the partner be informed of the diagnosis—not only because it facilitates adaptation, but because the partner's understanding significantly reduces the emotional impact of the disease.
When dyspareunia requires specialized attention
If dyspareunia persists despite good control of VLS with the correct treatment, there are additional clinical options worth exploring:
> Evaluation of anatomical changes that may be contributing—narrowing of the introitus, localized fibrosis
> Assessment for regenerative medicine if there is tissue damage that medical treatment has been unable to repair
> Specific pelvic floor physiotherapy
> In selected cases, reconstructive surgery
Sexual pain with VLS does not have to be permanent. If you are suffering from dyspareunia, consult your specialist—there are options.