Itchy Vulva? Lichen Sclerosus?

Your privates burning or itching like crazy.? Spend your time scratching, or squirming?itchy vulva

Are you getting no relief from the over the counter remedies?   You maybe have been given meds/creams to treat yeast, bacteria etc.   I hope  you have, at least, been examined.   I see many women who are too embarrassed to be examined by their family doctor – only to suffer on!!

First things first.   We have to get a history.  I know it’s old, but many women are paying the price for the sale on that new detergent!   Women are all being sold sprays, douches, hoo-hah creams.  …. All to keep us not smelling. All these potions can cause a chemical reaction in our delicate parts!!


So. Think about when this all started.  Did you get a new brand of panties,a new package of toilet paper- there are all kinds of chemicals in toilet paper.   New brand of condoms?  New soap/shaving lotion?  Are you itchy anywhere else? Your vulva is just skin, so if you have itchiness elsewhere, the itching in the vulva may be part of a body reaction.

Now, the other thing to consider is a thing called the ITCH SCRATCH CYCLE.


This happens a lot.   The original problem may be gone, but the scratching keeps the cycle going.  When you scratch, you damage the skin, and this causes the scratched skin to release chemicals that make you itch more– so you keep scratching.   Not a good set up!   We have to STOP the itching/scratching as quickly as possible.

There are other medical conditions can make you itch.   Diabetes is a big cause.   I see diabetics all the time who come in with chronic yeast infections or have a yeast dermatitis.   Let me tell you- we may be able to keep things a little better controlled, but NOTHING WORKS BETTER THAN NORMAL SUGARS!!    I don’t want to hear that your sugars are ” better ” than what they were before, and the complacency  about sugars in the double digits- and you’re ok with that.  Your sugars are either NORMAL – OR NOT!

yeast under breast

yeast pannus

Yeast under the breasts—looks same under belly , in groin , around vulva

Why do diabetics get yeast??  All you cooks know that when you are making bread, a little sugar really makes that yeast rise- so get those sugars normal!      You’ll be rubbing creams down there til you die!   Now there are things we can suggest to help you with your battle– read on under treatments.

it is also important to know if you have traveled in the last few months-one girl I saw had been in Africa, and actually had schistosomiasis (worms), of vulva—pretty darn rare!   You never know what might tip the clue to a diagnosis.

There is another condition called LICHEN SCLEROSUS, which I talk about later in this post.

So – after a history you gotta get up in those cursed stirrups, and get examined under good lighting!!

We need to check your anatomy, look for any lesions ( things that shouldn’t be there),  abnormal colouring, signs of scratching, discharge etc.   Sometimes everything can look completely normal, and all tests are negative.   That is when we try to stop that vicious cycle.

There are things you can do to break the ISC (itch scratch cycle).

Bathing in warm water with oatmeal, or Epsom salts.

If you are leaking urine, and that is felt to be cause of itching, then a barrier cream can help- baby cream with zinc oxide.   Vaseline is not very helpful.  Avoid scented pantiliners.  Get some help with treating he urine leak–incontinence is NOT part of normal aging.

Use cotton underwear.

Taking an antihistamine like ceftirazine and Benadryl.    The Benadryl may help you sleep at night.

Wearing gloves to bed to cover your fingernails.


We have LIGHTWEIGHT PORTABLE BIDETS (shove one in that 15 pound handbag of yours!)

Instead of scrubbing with a FACE (Not cootie!)-cloth(and you all use those really rough FACEcloths!), and gouging your rear end out with toilet paper–use a NOVA SCOTIA (MARITIME) BIDET  (Bee-day)   eh?!?!

How the heck can anybody get quadriceps strong enough to squat over those European Bidets–is just beyond me—these ketchup bottles are lightweight, inexpensive, easy to use and require no hanging over a low porcelain bowl trying not to

get soaked.   A patient once said she could even use a disposable water bottle—well–maybe ONCE in a public washroom–those things make a LOT of noise as they crinkle up–and don’t have the nozzle to ‘fine tune’ your aim!


There are are a few prescription creams that can be used.   I will often have women use clobetasol cream-a steroid cream.   Initially I will have them use it twice a day and then cut back to twice a week after a couple of weeks.  This would be long term if you have a chronic on-going skin problem, such as lichen sclerosus.

An anesthetic cream such as lidocaine, or Emla can also give quick relief, and can be a handy thing to have in your handbag.  You rub a little on the itchy area, and five minutes later you are numb – so you won’t scratch!

I often prescribe EMLA (an anesthetic cream), for women who have pain with intercourse, due to pain at the entrance to the vagina- typically on the bottom side- at the posterior fourchette.  It can save your sex life! You only need a DOT—I literally say, “Treat it like Estee LAudee for the hoohah!”

I had a pharmacist call me one time- incredulous that it was being put ” down there”. “But- the MAN will get some on his penis!!!!!” he says!!

So, let me get this straight–It’s OK for a woman to grit her teeth in agony to make her man happy- but HE might get a little numbing cream?   Well.  Repeat after me- “He’s getting some, he’s getting some, he’s getting some.   It takes five minutes to make you numb.  It is not going to numb his entire penis, and I haven’t had one single man complain- and- typically- he’ll be ‘done’ in less than 5 minutes.  He’ll fall asleep, and when he wakes up in the morning – it’s all worn off.   Not a problem!”

The pharmacist laughed, and said, ” That’s right!”   Now I need brain bleach every time I see him-I keep thinking ‘5 mins, 5 mins!’

If you do end up getting this cream, remember that a DOT does a LOT!!  Literally a dot the size of an orange seed is plenty!


The other thing you can do for vulva itching, or itching in your panti creases, or under your breasts, or your tummy muffin top, is to make sure you are thoroughly dry down there before you get dressed.   Then- you can use a deodorant stick, or roller ball- along the pantiline creases- and if you have a muffin top, you can lift that up and roll deodorant along your lower tummy bikini line.  It can do wonders to keep yeast under control- that nasty hot red skin that itches and burns.  Hey. You can rub it under your boobs too- and make sure it’s dry there too!!

Yeast – the deodorant helps a lot, and another is thorough drying.   If you feel you must use a powder (despite all these papers suggesting a link to ovarian cancer- don’t know for sure, but one law suit has been won)-then use an ANTIFUNGAL POWDER.   The powder for athletes foot works well.

If you can afford it- or you are in USA, you can get Athletes foot cream -active ingredient is clotrimazole- for ONE DOLLAR- at most supermarkets or dollar stores

Canesten $$$

yeastAthlete’s foot cream



Yeast in groin

More classic yeast

.  I swear- clotrimazole is what we prescribe,  and costs a LOT more.  It must be the same reason women’s shirts cost more to dry clean than men’s shirts!!   Put the word “vaginal” and it costs a whole lot more than the word ” foot”.   Again- just treat this cream like foundation  make-up.  You do not need to slather it on!!

if you are in USA  (or travel there), you can pick up 1% hydrocortisone at any dollar store.


You can put a DOT of this AND a DOT of clotrimazole (athlete’s foot cream), on your finger and rub this on your skin creases,if itchy and bright red.   It is same as Lotriderm HC ($$$)


Now- lichen sclerosus.   Pronounced ‘like en sklere oh suss”.  Nothing to like at all!  It is a chronic- typically life long condition.  We don’t have a clue why you get it!  It is seen in young girls, but way more common over age 50.  It is a common cause of burning, and itching sensation that doesn’t go away with yeast creams etc.

common appearance of lichen

this is stable lichen with still good anatomy—she has been a bit itchy on the left side as you can see recent scratch marks

An examination will be necessary, and the doctor can often diagnose by just looking at the area.   If you want to be absolutely sure, a biopsy can be done.  I tend to biopsy if patient requests a biopsy, or if I am not sure, or if I am concerned about cancer.   Rarely- lichen sclerosus can be associated with vulva cancers.

The treatment for lichen is the use of a steroid cream- clobetasol – and comfort measures as mentioned above.   If you do not keep lichen under control you can end up losing the normal appearance down there.  In severe cases you can actually end up looking like Barbie – no identifiable genitals at all -just smooth nothing with nothing but a pinhole for urine.  See how the lips just join together, and you ‘smooth out’?  Just about closed over!

Hey girls–you either USE it or LOSE it!!!

lichen sclerosus

Now –here is one vulva that has closed over–and has a tiny pinhole for urine to escape.

links for lichen:

Mayo Clinic info on lichen

Fast facts about lichen


Early lichen of vulva

Lichen Sclerosus is associated with vulva cancer.  This is a picture of a severe PRECANCEROUS area on the vulva.  We grade precancerous areas as mild, moderate and severe.  The recommended treatment is to excise it (cut it out), and to get a good clear margin.

This is an early vulva cancer from lichen

Lichen Sclerosus 2

The area has had freezing injected into it (this was done under “local”).  that is why is the area looks puffy.  A ink marker is used to outline the area that needs to be cut out.

Lichen Sclerosus 3

The area has been cut out.  It has to be cut long so that it will look better when sewn up–you can’t just cut a circle as that will not look right when sewn up–you want a nice looking “seam”

Lichen Sclerosus 4

So this is thte area having just been sewn up.  The clitoris has been left and the bleeding is under control.  So now it’s home with painkillers and using water baths a couple of times a day.  It will take about 4 weeks to heal.  The stitches dissolve on their own–thank GOD eh?

Lichen Sclerosus 5

This is the area a couple of days later—looking good–no swelling or bruising.

6 Replies to “Itchy Vulva? Lichen Sclerosus?”

  1. IM Paddock says:

    Hello. I just discovered your website, and already have learned so much – thank you..!
    I am a 59-year-old, post-menopausal mother of 4.
    I have been steadily acquiring knowledge of conditions that have annoyed me for decades, many of which I’d never “met”.
    Many of the conditions focus on the genital/perineal area, which has been rashy and uncomfortable my whole life. These conditions include, among others, lichen sclerosus, lichen planus, lupus erythematosus, vaginal atrophy, irritable bladder, and etc. As I take immunosuppressants, I am also susceptible to opportunistic infections, and have been treated for many, including yeast, fungus, staphylococcus, pseudomonas, etc.
    My words of wisdom: Find a good, available, responsive health care provider (eg: Dr. Sandland..!).
    Keep looking until you find someone you want on your team, as this could be a very-long-term relationship. My current MD has been my PCP for 20 years.
    Then come up with a treatment plan together, and heed it. Revise together as indicated.

  2. Jan Spencer says:

    One thing you haven’t mentioned is vulvar intraepithelial neoplasia (VIN) or cancer of the vulva. I had lichen sclerosis since my teens but nobody told me I had a higher chance of VIN or cancer of the vulva. When I itched down there I just put up with it but when I went for my 3 year smear test the nurse noticed a mass of white tissue around my perenium and insisted I get it checked out. Three months later I was having a partial vulvectomy for VIN3. VIN is a very real vulva condition that women don’t know about and because of HPV, another thing that puts you at risk, its on the up.

    Pay attention ladies. Check your vulva like you check your breasts. Warning signs of VIN can be just a constant itch but if you look closely, the skin often changes color… deep red, white or pigmented.

    1. admin says:

      actually VIN was mentioned but I have emphasized it a little more.
      I did say I check women every 6 months because of the risk of Vulva cancer.

  3. Lana Fayman says:

    How can we get research on vulvar lichen planus and lichen sclerosis? Lichen Sclerosis has really changed my life so it’s hard to enjoy anything and stop feeling the burning and itching. Please give me some ideas on how and/or who to contact in order to come up with better treatments.
    Thank you : )

    1. admin says:

      Are you also using a cream like EMLA? That can give some quick relief!

      There is a vulva society and foundation

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