About Vulvar Lichen Planus

Lichen planus is an inflammatory disease that can cause an itchy or burning rash, or painful purple lesions. Lichen planus is an inflammatory disease that can cause an itchy or burning rash, or painful purple lesions, on the skin of the arms or legs, or inside the mouth. It can also affect the vulva and vagina. While women may have lichen planus only in the genital area, it often affects other areas of the body where there are mucous membranes, especially the mouth, where it causes gum disease.

What Causes Lichen Planus?

The cause of lichen planus is unknown. It may be the result of an autoimmune problem in which the immune system becomes overactive and causes inflammation. It is not caused by an infection, aging or menopause, diet, hygiene practices or sexual activity.

Lichen planus is not contagious and cannot be passed to a sexual partner.

Symptoms of Lichen Planus

When lichen planus involves the genital area, women often have vaginal discharge, pain, burning, and itching in the genital area. Sometimes there are red, painful areas, called erosions, on the vulva. Scarring in the genital area can occur from chronic inflammation, causing changes in the appearance of the vulva, especially loss of the labia minora (inner, smaller lips of the vulva), and constriction, or tightening, of the vaginal opening.

When the vagina is involved, intercourse can be very painful due to erosions on the vaginal wall. There may also be an irritating discharge. Narrowing or shortening of the vaginal canal may occur and, as a result, penetration can become difficult or impossible.

Lichen planus in the mouth may cause red, ulcerated areas on gums, tongue, or on the inside of the cheeks. This must be treated by a dentist who is knowledgeable in the treatment of lichen planus.

If lichen planus affects skin, it is usually on the forearms, wrists and hands, or legs and ankles. It can look like a rash or spots that are purple in color, occasionally with white streaks on top of the rash.

Diagnosis of Lichen Planus

Lichen planus is diagnosed by examining the genital area, including the vagina, and looking for characteristic signs of the condition. During the exam, vaginal cultures and swabs may be collected to rule out other causes of inflammation. If the diagnosis is not certain or if the symptoms do not respond to treatment, a biopsy may be needed.

Treatment of Lichen Planus

In order to reduce inflammation and discomfort, it is important to stop the use of all irritating products in the genital area. The vulvar hygiene handout available at the Drexel Vaginitis Center includes a thorough guide to products that are recommended for use in the vulvar area and those that should be avoided.

Lichen planus usually responds to topical steroid ointments and vaginal creams. There is no one specific medication for lichen planus, and different medicines may be used depending on the symptoms and response to treatment. In women who are menopausal, estrogen given locally may help the vagina to heal. It is possible that lichen planus may disappear with treatment or it may come and go, not showing symptoms for long periods of time.

Because lichen planus can cause vaginal scarring, intercourse may become painful or full penetration may be impossible. Vaginal dilators can be used to gently stretch the vaginal tissue to allow for more comfortable intercourse. Rarely, surgery may be needed.

Once symptoms are under control, it is important to continue treatment. Regular examinations are needed to treat any new genital changes as soon as they appear, to prevent more scarring of genital tissue.

Lichen Planus and Vulvar Cancer

Lichen planus may be associated with an increased risk of vulvar cancer, but the overall risk is low (less than 5 percent). Women with lichen planus need to be examined carefully on a regular basis to make sure that there is no evidence of a cancer.

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

The images being used are for illustrative purposes only; any person depicted is a model.