Lichen Sclerosus

Lichen sclerosus is a chronic inflammatory skin condition that commonly affects the vulval area. It can cause changes to the skin, irritation, discomfort, and pain, and although it can occur at any age, it is most commonly diagnosed in women after menopause.

Lichen sclerosus is a medical condition that requires appropriate diagnosis and management, usually involving treatment prescribed by a GP, dermatologist, or gynaecologist. However, because symptoms can affect the tissues, muscles, confidence, and comfort around the pelvis, pelvic health physiotherapy can provide valuable support alongside medical care.

What are the symptoms of lichen sclerosus?

Symptoms vary between individuals but may include:

• Itching around the vulval area
• Burning or irritation
• Skin sensitivity
• Pain or discomfort
• Changes in skin texture or appearance
• Small tears or soreness
• Discomfort during sexual activity
• Increased awareness or anxiety around symptoms

Symptoms can fluctuate, with periods of improvement and flare-ups.

How can lichen sclerosus affect pelvic health?

Although lichen sclerosus primarily affects the skin, ongoing discomfort can influence the muscles and tissues of the pelvic region.

Some people develop:

• Increased pelvic floor muscle tension
• Protective muscle tightening
• Pain with touch or intimacy
• Reduced confidence with sexual activity
• Avoidance of exercise or certain activities

The pelvic floor muscles may become more guarded in response to ongoing irritation or pain, which can contribute to further discomfort.

How is lichen sclerosus diagnosed?

Diagnosis is usually made by a healthcare professional, often through:

• Assessment of symptoms
• Examination of the vulval skin
• Medical history
• Occasionally a biopsy if required

Pelvic health physiotherapists do not diagnose lichen sclerosus but can work alongside your medical team to support the functional impact of the condition.

How can pelvic health physiotherapy help?

Treatment is focused on improving comfort, confidence, and pelvic function.

Pelvic floor muscle assessment

Your physiotherapist can assess whether pelvic floor muscle tension may be contributing to symptoms.

Treatment may include:

• Relaxation strategies
• Breathing techniques
• Muscle coordination exercises
• Gentle mobility work

Supporting comfort and intimacy

Many women with lichen sclerosus experience discomfort or anxiety around intimacy.

Physiotherapy may help with:

• Understanding pain responses
• Reducing muscle guarding
• Improving confidence with movement and intimacy
• Advice around gradual return to comfortable activities

Exercise and lifestyle support

Your physiotherapist can help you maintain activity while considering symptom fluctuations and flare-ups.

Medical treatment alongside physiotherapy

Medical management is essential and often includes prescribed topical treatments to control inflammation and protect the skin.

It is important to continue regular medical review, as long-term monitoring is recommended.

Pelvic health physiotherapy works alongside this care to address symptoms that affect movement, comfort, and quality of life.

Supporting your pelvic health

Lichen sclerosus can be uncomfortable and emotionally challenging, but support is available.

A specialist pelvic health physiotherapist provides a confidential and sensitive environment to discuss symptoms that can sometimes feel difficult to talk about.