There are certain symptoms women will discuss over lunch without hesitation. Hot flashes? Absolutely. Achy knees? We can compare notes. The mysterious new chin hair that appears overnight with the structural integrity of piano wire? Everyone has a story.
Persistent vulvar itching tends to receive a little less table conversation. That silence can become a problem because itching, burning, soreness, or changes in the skin around the vulva are often automatically blamed on menopause, dryness, a stubborn yeast infection, or a new laundry detergent. Those are all possible explanations, but there is another condition women should know about: vulvar lichen sclerosus.
Lichen sclerosus is a chronic inflammatory skin disease that commonly affects the genital area. It can occur at any age, but older women represent an important group affected by the condition. A large 2025 JAMA Dermatology study of female Medicare beneficiaries found diagnosed vulvar lichen sclerosus in 0.7% of women ages 65 and older. The study included more than 2.5 million women. The researchers also noted that this figure may underestimate the true prevalence because sensitive symptoms and access to care can prevent diagnosis.
What Is Lichen Sclerosus?
Lichen sclerosus, usually abbreviated LS, causes inflammation and changes in the skin, most often around the vulva and sometimes the area surrounding the anus. The 2026 evidence- and consensus-based guideline on lichen sclerosus, developed by an interdisciplinary group of specialists, describes genital LS as a chronic condition that can cause itching, pain, fissures, whitening of the skin, scarring, and changes to normal genital anatomy.
Although we casually use the word “vagina” to describe practically everything south of the waistband, lichen sclerosus primarily affects the external genital skin, or vulva. It can involve the labia, skin around the clitoris, perineum, and skin near the anus rather than the vaginal canal itself.
The exact cause remains uncertain. Research points toward immune-system involvement, and LS has been associated with autoimmune diseases, including autoimmune thyroid disease, although having LS does not mean you automatically have another autoimmune condition. A 2023 population-based Swedish cohort of 5,680 people diagnosed with lichen sclerosus found associations with several autoimmune disorders, reinforcing the likely immune component without establishing one single cause.
Most importantly, LS is not caused by poor hygiene, and it is not something you can scrub away.
The Itch Can Be the First Clue
For many women, itching is the symptom that finally gets their attention. It may be mild and intermittent at first or intense enough to interfere with sleep.
Burning, soreness, tenderness, painful cracks in the skin, bruised-looking areas, discomfort with sex, and pain when urine touches irritated skin can also occur. On examination, the affected skin may look pale, ivory-white, thin, shiny, wrinkled, thickened in places, or easily damaged.
A 2025 systematic review examining thousands of reported lichen sclerosus cases found that pigment changes, itching, and loss of normal vulvar architecture were among the commonly reported findings in women. The review also documented pain, burning, erosions, fissures, bleeding, and sexual problems among the range of possible presentations.
Not every woman experiences every symptom. Some women have visible changes with surprisingly little discomfort, which is another reason LS can remain unnoticed until a clinician performs an examination.
Please Do Not Assume Every Itch Is a Yeast Infection
A vulvar itch has an astonishing ability to send us straight to the pharmacy antifungal aisle.
Yeast is certainly one possible cause of itching, but so are genitourinary syndrome of menopause, contact dermatitis, psoriasis, eczema, lichen planus, vulvodynia, infections, and lichen sclerosus. Specialized vulvar clinics routinely see women with overlapping conditions, and biopsy is sometimes necessary when the appearance is uncertain or treatment is not working.
If you have repeatedly treated yourself for “yeast infections” without a confirmed diagnosis and the same itch keeps returning, it is time to retire the guessing game.
The absence of discharge is also worth mentioning to your clinician. Lichen sclerosus is a skin disorder rather than a vaginal infection, so itching may occur without the discharge many women associate with yeast or bacterial infections.
Menopause Can Make the Confusion Worse
This is where things become particularly tricky after 50. Genitourinary syndrome of menopause, or GSM, can cause vulvar and vaginal dryness, irritation, burning, painful sex, and urinary symptoms as estrogen levels decline. PrimeWomen has covered those symptoms before, and they are very real. But GSM and lichen sclerosus are not the same condition, and a woman can have both at once.
The current 2026 lichen sclerosus guideline specifically recommends against using topical estrogen as a treatment for LS itself. Vaginal estrogen may still be appropriate when a woman also has GSM, but it does not replace treatment directed at the inflammatory skin disease.
That distinction matters. If estrogen helps the dryness but you still have a persistent white patch, tearing, severe itching, or progressive skin changes, do not assume you simply need more moisturizer. You may be dealing with two different problems sharing one very inconvenient address.
Take a Look—Yes, Really
Many of us inspect a questionable freckle on our shoulder from six different angles yet have never intentionally looked at our own vulva. A hand mirror can be surprisingly useful.
You are not trying to diagnose yourself. Instead, become familiar with what is normal for you so you can recognize a change. Look for areas that have become distinctly whiter than the surrounding skin, repeated cracks or sores, thickened patches, persistent redness, bruised-looking areas, or changes in the shape of the labia or skin around the clitoris.
If you notice something new, take that information to a gynecologist, dermatologist, or clinician experienced in vulvar conditions rather than launching an intensive Google Image investigation at 11:45 p.m.
Scarring Is One Reason Early Treatment Matters
Lichen sclerosus is not merely uncomfortable. Ongoing inflammation can lead to scarring and changes in vulvar anatomy.
The inner labia may become smaller or fuse with nearby tissue. Scar tissue can develop around the clitoral hood, and the vaginal opening can become narrower. These structural changes may contribute to painful sex and other functional problems.
Once significant scar tissue has formed, medication may control the active inflammation without completely reversing the anatomical change. That is one of the strongest arguments for treating the disease early rather than waiting until symptoms become unbearable.
This is also why “I can tolerate the itching” is not necessarily a treatment plan.
How Is Lichen Sclerosus Diagnosed?
An experienced clinician can often recognize a typical case by examining the vulva and taking a detailed history.
A biopsy is not required in every straightforward case. However, the current guideline recommends biopsy when the diagnosis is uncertain, when the condition fails to respond as expected, or when an area raises concern for a precancerous or cancerous change.
A vulvar biopsy involves removing a small sample of skin for examination under a microscope. That prospect understandably makes many women tense every muscle below the waist simply from reading the sentence, but the procedure is typically performed using local anesthetic.
If your clinician recommends one, ask exactly what they are trying to confirm or rule out. Understanding the reason tends to make any procedure considerably less mysterious.
Strong Steroids Are Not the Enemy Here
When women hear that the genital skin already appears delicate, the idea of putting a very strong steroid ointment on it can sound completely backward.
That concern makes sense for ordinary steroid use on healthy skin. Lichen sclerosus, however, is an inflammatory disease in which appropriately prescribed topical corticosteroids have decades of clinical use behind them and remain the recommended treatment. The goal is to suppress damaging inflammation, control symptoms, and help prevent progressive scarring.
Treatment frequently continues in some maintenance form after the initial flare is controlled because LS is chronic and can reactivate. The precise maintenance schedule varies, which is another reason periodic follow-up matters.
Do not abruptly stop a prescribed treatment simply because the itching disappears. Symptom relief and complete disease control are not necessarily the same thing.
What About Laser Treatments?
This is an area where marketing can run considerably faster than evidence. Lasers and other energy-based therapies have been promoted for a variety of vulvovaginal concerns, including lichen sclerosus. Research is ongoing, but current international guidance does not place laser ahead of topical corticosteroids as standard treatment.
In a double-blind, randomized, sham-controlled trial involving 40 women with biopsy-confirmed vulvar LS, fractional CO2 laser treatment did not produce a significant improvement in the primary histopathology outcome compared with sham treatment. The investigators concluded that fractional CO2 laser was not effective as monotherapy for vulvar lichen sclerosus.
If an expensive treatment is being offered as a replacement for standard medical therapy, ask which randomized trials support that specific device and whether your prescription treatment should continue.
Simple Products Can Make Daily Life More Comfortable
Prescription treatment controls the disease, but reducing everyday irritation can make the skin much happier.
The 2026 guideline recommends using bland emollients to support the skin barrier and protect against irritation from urine, sweat, soap, discharge, semen, and friction. Fragranced products and ingredients known to irritate or trigger contact allergy should be avoided when possible.
A fragrance-free emollient or plain barrier ointment can therefore be useful alongside prescribed treatment. Some women also benefit from an emollient soap substitute rather than fragranced body wash, while a simple lubricant can reduce friction when sex is uncomfortable. Official clinical guidance also recommends emollients as a soap substitute and barrier preparation.
This is not the moment to experiment with essential oils, perfumed “feminine” washes, exfoliating acids, scented wipes, or a botanical serum with 14 ingredients and very persuasive packaging. Bland is beautiful when irritated vulvar skin is involved.
Sex Should Not Become Something You Quietly Give Up
Lichen sclerosus can make intercourse uncomfortable when the skin is inflamed, fragile, fissured, or scarred. Sexual dysfunction and painful intercourse are well-described complications of the condition. Tell your doctor if sex hurts.
Treatment of active inflammation, management of any coexisting GSM, appropriate lubrication, and addressing scar-related narrowing can all be part of the conversation. Women with persistent structural problems may sometimes need additional specialist care after inflammation is controlled.
You are allowed to want comfortable skin and a comfortable sex life at 55, 65, 75, or beyond.
There Is a Cancer Risk but Keep It in Perspective
Vulvar lichen sclerosus is associated with an increased risk of vulvar squamous cell carcinoma, which is why treatment and continued surveillance are important. In the 2025 JAMA Dermatology Medicare study, 1.2% of women diagnosed with VLS subsequently had diagnostic codes for vulvar cutaneous squamous cell carcinoma or carcinoma in situ during follow-up; their risk was substantially higher than that of women without diagnosed LS. The authors also emphasized limitations inherent in claims-based research.
Other studies have produced different absolute estimates because populations, follow-up time, treatment, and diagnostic methods vary. The practical message is not that LS inevitably leads to cancer—it does not—but that a persistent new lump, ulcer, thickened area, color change, or sore that does not heal needs examination rather than another layer of moisturizer.
Regular follow-up also gives your clinician an opportunity to check whether the disease remains controlled and whether your maintenance treatment needs adjustment.
Make the Appointment You Have Been Avoiding
If vulvar itching has lasted for weeks, keeps returning, wakes you at night, or has not responded to treatment for a presumed infection, schedule an examination.
Make an appointment sooner if you notice white or thickened patches, repeated splitting or bleeding of the skin, sores that do not heal, a new lump, progressive changes in the shape of the labia, or increasing pain during sex. These features can occur with LS and sometimes warrant biopsy or specialist evaluation.
Start with your gynecologist, dermatologist, or primary-care clinician. If symptoms are persistent or the diagnosis remains uncertain, ask whether there is a vulvar-disorders specialist in your area.
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