What is Lichen Sclerosus?
Lichen Sclerosus (also known as LS or white spot disease) is a chronic condition that causes patchy, discolored, thin skin and usually affects the genital and anal area. The back, shoulders, upper arms and breasts are also common areas that can be affected. Those with LS often report symptoms such as smooth or blotchy discolored skin patches, itching, soreness or a burning sensation, easy bruising, fragile or extra sensitive skin, bleeding, blistering or open sores, and pain with sex.
Who does Lichen Sclerosus affect?
While anyone can get Lichen Sclerosus, post menopausal women, girls who have not started menstruating yet, and women who suffer from an autoimmune disease are most at risk. Although rare, it can also be seen in men. When found in males, the disease is known as balanitis xerotica obliterans.
What causes Lichen Sclerosus?
While the exact cause of LS has yet to be determined, it is thought to be related to genetics, immune disorders, trauma or infection.
What is the treatment for LS?
The mainstay of treatment is potent topical steroids in the case of genital involvement in women. Studies have shown that regular use of potent topical steroids in women prevents the problems of scarring and decreases risk of skin cancer developing in the area of lichen sclerosus. Potent topical steroids are also a first line treatment for other areas affected by lichen sclerosus.
There is a risk of squamous cell carcinoma with LS and so it is important to get regular screening.
Why do Lichen Sclerosis cause pelvic floor problems and what are they?
The most common distribution is a figure of 8 involving the vulva and perianal area. The head of the penis and other parts of the body may also be affected.Lichen sclerosus typically has a remitting relapsing course that is complicated by permanent scarring of the affected areas. This produces pelvic health problems such as difficulty in urination, defecation, and intercourse for affected women and difficulty in urination or with erections in men.
How can pelvic floor physical therapy help with Lichens Sclerosus?
We believe in the whole body evaluation and care when it comes to treating LS. This is because pelvic floor is not isolated, it is connected through joints and muscles and nerves. For example, there might be a muscle or trigger point in your pelvic floor that might be referring pain in to your abdomen or legs, and your tight TMJ might be causing pain in to you pelvic floor or the way you move and sit might be causing pelvic floor dysfunction. While lichen sclerosus may be present in the vaginal or anal region, we find that our patients have myofascial and musculoskeletal problems in the abdomen, low back, hips, posture or inner thighs. Is it in your best interest for us to look at all these areas for optimized care and to minimize pain and inflammation along with any pelvic dysfunction.
What is Pelvic Physical Therapy for Scarring and pelvic floor dysfunction with Lichens Sclerosus?
Many patients that come to us with lichens sclerosus or lichens planus have been told either by gyn or their friends or through social media about possible pelvic floor dysfunction. A lot of them also do keels from google search or social media but kegels can actually do more harm and increase symptoms, so if you do have any symptoms such as vulvar or vaginal pain, urinary urgency, frequency, constipation, painful sex, lower abdominal pain, refrain from kegels. Pelvic floor dysfunction in LS is most likely due to overactive or tight pelvic floor muscles to say in the simple terms. Dr.Soni works with patients to improve their understanding of their symptoms, and give them ways to manage it as a primary part of the treatment so you are not anxious or dependent during a flare up. She uses manual therapy techniques and modalities along with a home program to help people overcome pelvic floor dysfunction with LS.
Why is intimacy painful with Lichen Sclerosus? Pelvic Physical Therapy can help with painfree sex with Lichens Sclerosus.
Skin around the labia, clitoral hood, vaginal canal can become fibrotic from the scarring, there is also increased sensitivity in these areas, due to which it can lead to painful sex. We have worked with people who could not tolerate a digital exam due to excruciating pain but were able to enjoy pain free sex after therapy. You can schedule a free 15 min phone call to talk to our pelvic health specialist here or call us at 908-509-1771
Do everyone need dilator therapy with Lichens Sclerosus?
Dilator has a time and place in treatment of lichens sclerosus. The use of dilator is to keep the vaginal canal from narrowing due to scarring to avoid having pain with penetrative sex, gyn exam, tampon use etc. But using it too soon in the treatment when the tissue are sensitive and progressing too fast can cause increases pain and scarring from micro tears or tears. It is important to work with specialist who has experience working with Lichen Sclerosus patients.
Are you recently diagnosed with Lichens Sclerosus or suspect your pelvic floor dysfunction is from LS? It is not late to have a experienced pelvic floor physical therapist on your team to avoid further scarring or pelvic floor dysfunction.
Many of the patients that we see go undiagnosed for years or are dismissed for their pain or treatment with wrong medicines or methods due to inexperienced clinicians. Dr.Soni works alongside a vulvar specialist MD and encourages all patients to have a vulvar specialist MD who has experience treating LS along with a pelvic physical therapist.
If you or someone you know is currently struggling with Lichen Sclerosus and is looking for a solution, simply click the button below to schedule a phone consult with a PT or call us at 908-509-1771