Dermatologist vs Gynecologist for Lichen Sclerosis?

As a nurse practitioner who has worked in sexual and reproductive health for about 15 years- I thought I might share a few thoughts. Please please talk to your own provider- these are just my general thoughts about LS!

My favorite website (meant for healthcare providers but open to anyone): vulvovaginaldisorders.org. It has some really great info on vulvar and vaginal disorders.

Having worked with different guidelines over the years- I think you do see kind of 2 approaches out there. One approach (maybe a little old school) was to only treat if the person was symptomatic (itching/pain). The newer guidelines/recommendations focus on 2 goals when treating LS: 1) help a symptomatic person to become symptom free and 2) preserve the “architecture” of the vulva.

With LS, over the long term, you can see changes almost like the labia disappear. In the most severe circumstances, it can lead to scarring across the vulva that interferes with sex or even with the ability to urinate.

When I’m talking to people about LS, I do like to offer a biopsy so that we are certain of the diagnosis but I wouldn’t be opposed to just treating someone if they really didn’t want a biopsy. As for potent topical steroids? Yes! There are very few times where we use strong steroids on the genitals/vulva, but LS is one of them. The goal (again) being to lessen the chronic inflammation, which helps keep the tissue/structure healthy and keeps the person symptom-free.

Usually treatment is started off with steroids being used every day for a few weeks, then every other day for a while, sometimes people can stop the steroids altogether while others need to be on some kind of weekly/twice a week maintenance dose.

My general advice here is this: ask your provider what the goals are for treatment! They should be prepared to help you get symptom free AND should want to prevent the scarring changes that can come from LS.

I’m 76 and have had Lichen Sclerosus for many years. I recently developed a very painful boil on my genital region. No matter how scrupulously clean you are, these things happen. I also use oestrogen pessaries and steroid cream. It’s a real uphill battle. I am totally convinced that stress worsens the condition.

What you have could be an inflamed Bartholin gland, aka Bartholin’s cyst. It may need to be surgically removed. If it’s not just a normal boil that releases contents and goes away get it checked by your gynaecologist.
I’m so sorry you have LS. It’s so painful. I never can decide it I’m stressed because of the LS, or if stress is enhancing the LS.

That’s very useful information. Thanks. I live in the UK and our waiting lists are rather long to see a consultant. I totally agree. I never quite can work out whether the LS pain caused the stress or other way around. I read that the least stressful occupation is a Chinese rice farmer! I’m listening to ‘ The Wind in the Willows’. That always delights mev

Yes, STRESS is a big factor. I went to a counselor who advised me to make a list of all the things I loved to do as a child and one activity will jump out at you. By God it worked. I renewed my love of coloring books. Sounds silly for a 72 year old, but when I am coloring I'm at peace. Good thing adult coloring books are in stores now, only using colored pencils. Good luck to all of you. Make that list today! 🤔 🤗

I loved colouring books too. At the moment I’m knitting myself a lilac coloured scarf. It’s a simple pattern. My cat insists on helping by chewing the wool.
I often sit in my very small garden and watch for birds. Sparrows fly at enormous speeds!

We are day-to-day people. It really sounds relaxing in your garden......I'll bring my coloring book & pencils 😎 and sit in the sun with you! I've done a lot of crocheting in my lifetime. Now, one day my hands (arthritis) will let me and some days they won't. Learning to accept one day at a time is a stress buster too. Too bad it took me so long and a lot of anger to realize it. Hope you have a good day and thank you for commenting back.

Hello
It’s very wise to take one day at a time. I have spinal arthritis so I knit whilst lying on my bed. It was a bit tricky at first but I’ve mastered the knack.
I live in Bournemouth England. It’s a seaside town. I may be brave and go for a paddle but the English Channel is very cold at the moment.

My computer keeps shutting down on me. . . I don't know if you got my incomplete messages not.

I live in UPSTATE NEW YORK, USA and my arthritis limits my walking and I drop things when my hands haunt me. You must have a lot of pain. . . . . I wouldn't go near the English Channel. I wouldn't anyway as I can't swim actually I'm afraid of the water. I like the scenery though.. Hopefully you can see the water from your home.

It's empowering your solving the awkwardness so you can do what you enjoy in bed. Take care and keep going strong.

I too find coloring on my I pad relaxing and unstressful. I have a shoulder needing replacement but this requires less movement and effort than pencil or crayons on paper. We must find ways to enjoy something. I also read book after book on my I pad. Easier on old eyes than a paper book and I can increase the size of print. Blessings to each of you as we take one day at a time.