Vulva appearance and lichen sclerosis

[aj2234]

Hi there. Just wondering if you could shed some insight about vulva appearance in terms of what’s normal and not, and what lichen sclerosis is like.

To contextualise, in January I was really sick and needed to take strong antibiotics. They made my vulva itch like mad to the point where I needed to slap it to stop myself from itching, and I suffered from tears and bleeding when the area was even lightly touched. I was trying to establish what was wrong, as I’d never gotten this reaction before. When I looked, I noticed that my vagina looked very pale, particularly in certain areas. Of course, I Googled this, and ‘lichen sclerosis’ came up.

A few months later I went to a gynaecologist as I’d never received a pap smear and thought a two-for-one deal would work well. At this point in time, most of the paleness had calmed, aside from one patch of definitively whiter/paler vulva skin.

He said if I hadn’t brought it to his attention, he wouldn’t have noticed it. He suggested that it was not characteristic of lichen sclerosis, but to monitor how the patch was progressing and to come back if it changed.

It’s been several months now. So I don’t examine my vagina to the point of insanity, I’ve set myself a goal of monitoring the patch once a month. This month, although I can’t be sure, it seems as though it’s bigger. I’ve tried to take photos across months, but this hasn’t proved helpful as it’s in a fold of my labia, so to look at the whiteness, I have to stretch it and make it bigger than it is. After taking another dose of antibiotics since my gynaecologist visit, I now know that the tearing and itch was from the medicine, rather than from the white patch. I still experience itching, but more in that tight underwear, bike riding, crossing your legs for too long kind of way.

I’m not quite sure about what to do with the patch. I would like to go back to the gynaecologist for peace of mind, but it is a bit out of my price range for peace of mind. And, last time he said the patch was too small for a biopsy. While there is every possibility that the whiteness was there even before the antibiotics started (as it’s not like I spread open every wrinkle in my labia in front of a mirror often!) I’m just not sure.

I will likely present it to a GP, but the issue here is that when I was ill in January, I was ill on public holidays and university days and ended up seeing a number of different doctors. I’m trying to re-establish a regular doctor, but it’s not so helpful as the doctor does not have the history of this issue.

I was just wondering if you had any advice on where to go from here, as well as whether the whiteness could be ‘normal’. I’m getting a bit paranoid now – I feel like the area above my clitoral hood is a bit paler than normal, but it’s also a place that faces a lot of pressure from the way I masturbate (non-painful, although it currently feels a bit overused).

Also, I was just wondering if there was a particular way to distinguish regular or pale vulva skin from that which has lichen sclerosis on it? I’m not fully versed on what the symptoms are, and for me, this skin feels and acts identical to other parts – it’s just paler.

Thank you for any help you can give!

[Karyn]

Genital appearance varies so widely, including in skin tone, that a doctor is really the only person who will be able to tell you whether or not what you're seeing is cause for concern. Since you are having some itching, I'd suggest checking in with a GP; it could be that you have a minor yeast infection or something along those lines but you can ask about this skin patch at the same time. My understanding too is that lichen sclerosus is often better treated by a dermatologist, so it might be worth asking for a referral.

(I also want to check in with you about how you're managing your anxiety; I know you've mentioned anxiety around health issues in the past and I believe you were seeing a psychologist. Are you still seeing them, and if so, how would you feel about mentioning your stress about this to them?)

[aj2234]

I will probably check in with my GP. Depending on what she says I may consult a dermatologist - money is also an issue there as well (specialists are never cheap!)

So, there is nothing really tell-tale about LS beyond more 'severe' symptoms that I can use in performing a monthly self-assessment?

It's going okay. Not presently seeing a psychologist, and I'm content with that. I am finding myself 'catching' on ideas a bit more than usual, like this (as in, worrying about something and not being able to let it slide), but I'm better able to talk myself out of anxiety than I was. For instance, the gynaecologist did say it didn't seem to be a typical presentation of the condition, which is always calming. In the last three months I've started a fulltime job so time management is a bit out of whack with seeing doctors, specialists, and psychologists right now.

[Karyn]

Adjusting to full time work can take some time, for sure.

Per the defining symptoms of lichen sclerosus, that's something best asked of a doctor when you get a chance to see them. However, to the best of my knowledge, lichen sclerosus isn't all that common, and I'd say that since the gynaecologist you saw didn't think there was a problem, then there isn't cause for you to be concerned.

Glad to hear that you're feeling able to manage your anxiety at the moment.

[aj2234]

Uh, it can! It's nice though - some of my friends are going through the same thing so as hard as it is to have the time constraint, at least there's others going through it.

Thank you for that. While I've also heard that dermatologists are good for diagnosing this, this gynaecologist was good and thorough so I think I'll agree with you there. But, still show my GP just in case.

Thanks Karyn! Hard at times, but I'm pleased to be pushing through. I really appreciate you checking up on me.

[Karyn]

Of course! Glad to help.