your pelvic health: support from a pelvic floor physical therapist

As pelvic floor physical therapists in Denver, Colorado, our practice has seen many patients suffering from Lichen Sclerosus and its ongoing flare ups. Let’s first break down what it is, and then read to the end to get our personal tips and resources to help you cope with flare ups. Consider making an appointment if you live near Denver, Colorado. You can book by clicking here.

First of all, What is Lichen Sclerosus?

Lichen Sclerosus is a chronic, inflammatory skin condition that usually affects the perineum (anogenital region) that results in scarring and weakening of the skin. It is not contagious and cannot be spread through sexual contact. Common symptoms include:

• Itching

• Burning

• Patches of skin discoloration

• Formation of sores/blisters

• Skin fragility with increased risk of bruising and/or tearing

• Changes in the ability to urinate (ie. weak urine stream) 

• Painful sex

Lichen Sclerosus causes scar tissue build up, which reduces tissue flexibility and can lead to discomfort with things like penetrative intercourse, inserting a tampon, and gynecological exams. 

Who is at risk?

While anybody at any age can develop Lichen Sclerosus, it is most common in:

• Post menopausal women

• People who have another autoimmune diagnosis (ie. hypothyroidism)

• People with an uncircumcised penis

• People with a family history of Lichen Sclerosus

What causes it?

It is still largely unclear what causes Lichen Sclerosus, however, it is widely accepted by healthcare professionals and researchers to be an autoimmune diagnosis. With autoimmune conditions, the body’s immune system attacks healthy cells, rather than solely attacking diseased cells, bacteria, and viruses. In the case of Lichen Sclerosus, the immune system begins to attack skin cells in the anogenital region, leading to the above symptoms.

Lichen Sclerosus can commonly be triggered by hormonal changes, trauma, and in rare cases it can be passed down genetically.

What can I do about it?

First, if you suspect you may have Lichen Sclerosus, it is recommended that you schedule a visit with your physician. A biopsy is required to confirm the diagnosis, if suspected.  Generally, they will prescribe a topical cream that you can use on the perineum to relieve symptoms and calm inflammation of the tissues.  Pelvic floor physical therapists are also trained to look for the skin changes in the perineum and will refer back to the physician.  

Ways to Prevent and Reduce Severity of Lichen Sclerosius Flare Ups

You can also do things on your own to alleviate symptoms and prevent flare ups. Ultimately, it is important to reduce friction and irritation of the perineal tissues.

Here are some things to consider:

• Use just warm water (no soap!) to wash the perineum, pat dry (don’t rub!), and apply a moisturizer immediately following to prevent drying out the tissue.

• We recommend using a vulvovaginal moisturizer such as those offered by Good Clean Love (https://goodcleanlove.com/collections/vaginal-care-collection/products/bionourish%C2%AE-ultra-moisturizing-vaginal-gel-with-hyaluronic-acid-assortment?variant=42220336218296)

• Soak in a Sitz Bath full of warm water twice a day and after intercourse for 10-15 min. Pat dry and make sure you apply a vulvovaginal moisturizer afterwards to seal in moisture!

• You can purchase a Sitz Bath at your local drugstore or on Amazon (https://www.amazon.com/Foldable-Discreet-Postpartum-Hemorrhoids-Episiotomy/dp/B08CDNFMLC/ref=sr_1_3_sspa?crid=AD152CAIVNXC&keywords=sitz+bath&qid=1706558716&sprefix=sitz+bath%2Caps%2C142&sr=8-3-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1 )

• Avoid heavily scented soap, moisturizer, and laundry detergent, as this could cause skin irritation.

• Wear breathable, cotton underwear and avoid synthetic and/or more abrasive materials (ie. lace, silk).

• Wear loose fitting clothing, if needed.

• Avoid prolonged pressure on the perineum (ie. riding a bicycle, horseback riding, riding a motorcycle, etc.).

• Change out of wet and/or sweaty clothing right away.

• Use lubricant during intercourse

• We recommend the following: 

• Good Clean Love (https://goodcleanlove.com/collections/personal-lubricants-collection/products/bionude%C2%AE-ultra-sensitive-personal-lubricant-assortment?variant=42220336644280)

• Maude Organics (https://getmaude.com/products/shine-organic-lube)

• Uberlube (https://uberlube.com/products/uberlube-glass-bottle)

• Sliquid (https://sliquid.com/shop/sliquid-naturals/h2o-sliquid-naturals/ )

• Consider removing inflammatory foods from your diet (ie. dairy, gluten, refined sugar, alcohol, heavily processed foods, etc.) as these can lead to sustained systemic inflammation and worsening of symptoms.

• Consider techniques to manage stress, as stress and anxiety can be major triggers for flare ups. Consider seeing a mental health therapist (contact us for recommendations!), practicing deep breathing and relaxation techniques, trying regular meditation, and ensuring you are getting 7-9 hours of sleep a night. 

• Talk with your medical physician about a prescription for low-dose estrogen (and/or testosterone, if appropriate) in cases where there are hormonally-driven symptoms such as genitourinary syndrome of menopause (AKA volvovaginal atrophy).

• Try using dilators with lubrication to help slowly and progressively stretch the perineum and restore flexibility of the tissues.

• We recommend one of these sets by Intimate Rose: (https://www.intimaterose.com/collections/vaginal-dilators?gad_source=1&gclid=CjwKCAiAtt2tBhBDEiwALZuhAMFyE4Mu-_xp07fZ5eeNAIvuCg5sQDQsLJCd2A2uKZ_KUWZKQyf4zBoC0sQQAvD_BwE )

it is also recommended to see a physical therapist that specializes in pelvic health. (We can help!)

Physical therapy can help preserve flexibility in the tissues and prevent scarring with the use of manual techniques. These techniques aim to promote blood flow and optimize pelvic floor function.

Pelvic floor PT will also improve adjacent muscle pain and/or dysfunction by taking a total body approach to your care and optimizing the function of ALL your systems. The aim is to ultimately reduce pain with penetrative activity (ie. intercourse, inserting a tampon, gynecological exams, etc.), improve bowel/bladder activity, reduce itching, burning, and stiffness, and get you back to leading the life you want to live!