The vulval skin appears white and there may be some cracks. The resulting scarring leads to destruction of the normal vulval anatomy with a tendency for the labia minorae to shrink and the clitoris may become hidden. The diameter of the introitus (vaginal entrance) may be reduced so that intercourse becomes painful or impossible. The principal symptoms are discomfort and irritation. There is a relationship to autoimmune disease(Q12.17) notably of the thyroid gland.

The exact cause of this condition is not known. There have been many names applied to chronic vulval skin conditions. These have included leucoplakia, kraurosis vulvae, Bowen’s disease and Paget’s disease. At one time they were all grouped as vulval dystrophies. With lichen sclerosus, there are inflammatory cells below the skin. Biopsy of the affected vulval skin is sometimes undertaken to confirm the diagnosis although it is now considered reasonable to confine biopsy to patients who do not respond to local medication.

Although patients presenting with cancer of the vulva often have associated lichen sclerosus, most patients with lichen sclerosus will never develop vulval cancer. To provide reassurance, however, gynaecologists tend to keep patients with lichen sclerosus under review.

At times it may be appropriate to take a small vulval skin biopsy and assess it under the microscope - histopathology. Skin biopsy is discussed at http://www. Answers.com/topic/skin-biopsy?cat=health

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