Symptoms of vulvar lichen sclerosus
The most well-known symptom of VLS is itching. But the clinical spectrum is broader — and fully recognizing it is the first step toward seeking the correct diagnosis.
Vulvar pruritus: the defining symptom of the disease
Vulvar pruritus —itching— is the most frequent and disabling symptom of vulvar lichen sclerosus. It is present in most VLS patients at some point during its progression. But it is not an ordinary itch.
Patients describe it with specific characteristics that distinguish it from itching caused by infection or local irritation: it is persistent —it does not go away with scratching—, worsens with heat and at night, and can be so intense that it interrupts sleep. Unlike itching from a yeast infection, it is not relieved by antifungals.
Continuous scratching can cause erosions and fissures in the vulvar area, which become an additional source of pain and an entry point for secondary infections.
All symptoms of vulvar lichen sclerosus
Local symptoms
Vulvar burning and stinging
A sensation of heat or burning in the vulvar area, which can be continuous or triggered by certain stimuli —clothing, urine, contact. Many patients describe it as an internal burning that is not directly related to itching.
Vulvar pain
In more advanced stages or during disease flare-ups, vulvar pain may be the dominant symptom. It can be spontaneous —at rest— or triggered by pressure, contact, or movement.
Fissures and erosions
Fissures are small linear cracks in the vulvar skin, especially common in the folds and the posterior commissure. They are painful, can bleed, and tend to recur. Their presence should raise concern about disease activity.
Dyspareunia
Pain during sexual intercourse is one of the symptoms with the greatest impact on quality of life. It is caused by the atrophy and fragility of the vulvar tissue and the possible narrowing of the vaginal introitus. In many cases, it leads to the abandonment of sexual activity, with the consequences this has on the couple's life and emotional well-being.
Difficulty urinating
In some cases, VLS can cause stinging or pain when urinating, especially if there are active erosions in the perimeatal area.
Systemic symptoms and impact on quality of life
VLS does not produce systemic symptoms —fever, fatigue, weight loss— but its impact on quality of life can be very significant:
Sleep disturbances
Nocturnal pruritus can chronically interrupt sleep
Limitation of activities
Tight clothing, physical exercise, prolonged sitting can intensify symptoms
Emotional impact
The intimate nature of the disease and its chronicity generate anxiety, shame, and isolation in many patients
Deterioration of sexual life
Dyspareunia and the fear of pain can lead to the abandonment of intimate relations
When you should consult a specialist
Consult a specialist in vulvar pathology if you present any of these situations:
> Persistent vulvar itching for more than 4-6 weeks without an identified cause
> Itching that does not respond to antifungals or standard treatments
> Changes in the appearance of the vulvar skin —white patches, atrophy, loss of elasticity
> Recurrent fissures without a clear cause
> Pain during sexual intercourse that has recently appeared or intensified
> Previous diagnosis of VLS with doubts about the treatment or its progression
Diagnostic delay in VLS has consequences: the longer it goes without proper treatment, the greater the probability that tissue changes will accumulate and some anatomical alterations will become irreversible.