Frequently asked questions about vulvar lichen sclerosus
The most common questions we receive in consultation regarding VLS, answered with the same clarity as we would in person.
About the disease
What is vulvar lichen sclerosus?
Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease of autoimmune origin that primarily affects the vulvar area. It causes intense itching, skin changes—such as white patches and atrophy—and can lead to progressive anatomical alterations. It is a manageable chronic condition, not curable in the sense of permanent elimination.
Does vulvar lichen sclerosus have a cure?"
No. Vulvar lichen sclerosus is a chronic disease of autoimmune origin. There is no treatment that permanently eliminates the underlying predisposition. However, with appropriate treatment—primarily ultra-potent topical corticosteroids—the disease can be well controlled, with a significant reduction in symptoms and stabilization of progression.
What are the symptoms of vulvar lichen sclerosus?
The most characteristic symptom is intense, persistent, and often nocturnal vulvar pruritus. Other common symptoms include vulvar burning and stinging, recurrent fissures and erosions, pain during sexual intercourse (dyspareunia), changes in the appearance of the vulvar skin—white patches, loss of elasticity—and, in advanced stages, anatomical changes such as fusion of the labia minora or narrowing of the introitus.
Is vulvar lichen sclerosus contagious?
No. Vulvar lichen sclerosus is not an infectious or contagious disease. It is not transmitted through sexual contact, clothing, or any other means. It is an autoimmune disease.
Is vulvar lichen sclerosus hereditary?
There is a genetic component to VLS: women with a family history of VLS or other autoimmune diseases have a higher risk of developing it. However, it is not transmitted directly from mother to daughter—what is inherited is a predisposition, not the disease itself.
About the diagnosis
How is vulvar lichen sclerosus diagnosed?
The diagnosis is primarily clinical: it is based on the patient’s history and a physical examination of the vulvar area. A specialist with experience in vulvar pathology can diagnose VLS in the clinic when the presentation is characteristic. A vulvar biopsy is indicated when there are diagnostic doubts, when treatment does not yield the expected results, or when there is a need to rule out associated malignancy.
Can vulvar lichen sclerosus cause cancer?
VLS is associated with an increased risk of vulvar squamous cell carcinoma. Studies estimate this lifetime risk to be between 3% and 5%—significantly higher than in the general population, but the vast majority of women with VLS will not develop carcinoma. Regular clinical follow-up with a specialist is the most effective measure for early detection of any suspicious changes.
About the treatment
What is the treatment for vulvar lichen sclerosus?
The first line of treatment is ultra-potent topical corticosteroids—primarily 0.05% clobetasol propionate—according to international guidelines (ISSVD, BAD 2018, and EADV 2024). For patients with an insufficient response or significant tissue damage, additional options such as topical tacrolimus and regenerative medicine are available. The Liquenia® Treatment is a specific regenerative protocol for VLS with published clinical evidence.
Do I have to use corticosteroids for the rest of my life?
In most cases, yes—although the regimen changes over time. The initial phase of treatment is more intensive; subsequently, it transitions to a maintenance regimen with reduced dosage and frequency. The goal is to keep the disease controlled with the minimum effective amount of corticosteroid. Discontinuing treatment usually leads to a relapse of symptoms.
Are there alternatives to corticosteroids?
Yes. Topical tacrolimus is an alternative for patients who do not tolerate corticosteroids or in areas where their prolonged use is problematic. Regenerative medicine—specifically the Liquenia® Treatment—offers an option for patients with an insufficient response or significant tissue damage.
About follow-up and quality of life
Does vulvar lichen sclerosus go away on its own?
Generally, no. VLS is a chronic disease that tends to progress without treatment. In some cases, especially in girls who develop it during childhood, it may experience spontaneous improvement with puberty. In adult women, spontaneous remission without treatment is exceptional.
Can I have sexual intercourse with VLS?
Yes, although VLS can cause pain during sexual intercourse (dyspareunia) that makes intercourse difficult or impossible during active phases of the disease. With appropriate treatment, many patients regain the ability to have pain-free intercourse. In cases with significant anatomical changes, an additional approach may be necessary.
How often should I have check-ups?
International clinical guidelines recommend regular follow-up for all patients with VLS, regardless of disease control. In general, at least one annual check-up with a specialist in vulvar pathology is recommended. The frequency may increase for patients with active disease, new clinical changes, or additional risk factors.
Does pregnancy affect vulvar lichen sclerosus?
Data on the interaction between VLS and pregnancy are limited. Some patients report improvement during pregnancy, possibly related to hormonal changes. After childbirth, the disease may reactivate. If you have VLS and are planning a pregnancy, consult your specialist to adapt the treatment.
Can I use standard intimate hygiene products?
With VLS, it is important to avoid products with perfumes, aggressive preservatives, or inappropriate pH levels. Conventional soaps and gels can irritate the vulvar area and worsen symptoms. We recommend specific products for sensitive skin that are fragrance-free and have a physiological pH. For more information on topical care, also consult Dermnix, the intimate oil specifically formulated for women with lichen sclerosus.
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