What is Lichen Sclerosus? A condition every woman should know about

In India and many parts of the world, discussions about women’s sexual and reproductive health have always been neglected. It is observed that even when women notice changes in their bodies, they frequently ignore them. Most women avoid discussing their health concerns with their spouses or healthcare providers due to stigma and a lack of awareness about sexual & reproductive health.

Recently, Dr. Kumta treated a patient with complicated Lichen Sclerosus. 46-year-old Geeta (name changed) was referred to

Fortis Hospital, Mulund for a case of Urinary Fistula. For a period of 15 days, she was leaking urine soon after she went to the washroom to pass urine. On local examination, the doctor noticed depigmentation in the vulval area. No urethral and vaginal openings were seen, and Labia & Clitoris could not be identified separately.

The patient believed it was Leukoderma and avoided seeing a doctor for a long time. The taboo and social stigma involved lowered her self-esteem. She was terribly embarrassed by this discoloration and had not been sexually active for a long time. She was forced to see a doctor only when she had Urinary Incontinence (leaking). During the initial examination, a biopsy was taken of the fused skin and, the clinical presentation suggested that the patient had Lichen Sclerosus.

What is Lichen Sclerosus?

Lichen Sclerosus is an autoimmune, chronic, inflammatory skin condition with a genetic predisposition. It typically affects the genital (Vulva, Labia) or anal regions. It is common in two age groups, childhood, and post-menopausal age group. If ignored or left untreated there is a 4 to 6% risk of developing Squamous Cell Skin Cancer. In a study by Dr. Smriti Naswa, among 311 women with vulval skin problems, 37 (12%) women had Lichen Sclerosus. She has also reported Vulval and Clitoris Skin Cancer in patients with Lichen Sclerosus.

Symptoms of Lichen Sclerosus:

The telltale signs of Lichen Sclerosus initially appear on the genital and anal skin. Visit your Gynecologist if notice any of the following symptoms:

Intractable itching and/or soreness near the Vulva

Severe pain during intercourse

Easy bruising, cracking, and peeling of the vulva

Depigmentation (loss of color) of skin

Pain/ burning while passing urine

Fecal/ urinary incontinence (leaking)

In Geeta’s case, after the diagnosis of Lichen Sclerosus was made, Dr Kumta carried out a surgical procedure to create an opening in the vagina. A telescope was inserted through the vaginal opening, and internal organs were examined; the Uterus, Cervix, and Urinary Bladder were found to be intact. Labial and vaginal reconstruction was performed. Geeta recovered well after surgery and has been taught to use a vaginal dilator to slowly stretch and widen the vaginal opening. Her symptoms have subsided completely and there is no urinary leakage anymore.

Treatment of Lichen Sclerosus:

Early diagnosis and prompt treatment is critical to prevent complications. Treatment includes topical potent steroid creams given under the supervision of a Dermatologist. Follow-up is usually for a lifetime. Early surgical treatment to decrease adhesions is not warranted as that can aggravate the disease process. Surgical intervention by a Gynecologist is needed

in case of complications like urinary leaking/ incontinence or menstrual difficulties, due to narrowing of the vaginal opening, if the Labia are fused. Cancer Surgeon’s opinion is needed if Vulval Cancer is suspected. Geeta in her follow ups with Dr Naswa has shown significant improvement in her skin fusion and her itching has subsided a lot, and she feels she has improved symptomatically. Geeta has been taught how to prevent the urethral and vaginal openings from getting smaller again.

Geeta neglected her symptoms and did not seek care until she developed Urinary Incontinence, a complication of Lichen Sclerosus. Many women like her do not take their symptoms seriously until it is too late. Lichen Sclerosus is a clinical condition that can be easily diagnosed by your doctor. The social taboo, embarrassment, and privacy issues associated with reproductive health prevent women from seeking help early. We need to be aggressive about educating and empowering women to talk about their symptoms and seek help sooner. In the end, it is prudent that women take charge of their own

health.

(Dr Sonal Kumta & Dr Smriti Naswa Singh (The authors) are Senior Consultant-Obstetrician & Gynecologist & Consultant-Dermatologist & Cosmetic Dermatologist, Fortis Hospital, Mulund. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.) Financialexpress.com