What is Lichen Sclerosus?
It’s an inflammatory condition affecting, most often women’s privates, but can occur in the genital and anal area of both men, women, and kids. It’s often precipitated by hormone changes such as perimenopause and menopause. Many women don’t realize they have it and many doctors don’t recognize it.
Often women present with itching, and they think they have a yeast infection. If left untreated, it can lead to scarring, loss of the normal anatomy, pain with intercourse and risk of cancer. Most doctors treat Lichen Sclerosus with Clobetasol, a very strong steroid that generally needs to be used for life. Even with treatment some women have persistent symptoms.
Through clinical experience and reviewing the literature I believe that Lichen Sclerosus is an autoimmune-mediated condition, and a lack of hormones or a precipitating event, like an infection or exposure, can trigger it, and hence why we often see it in perimenopause and menopause, but it can happen at any stage. I believe that stress, certain foods like gluten, viruses, especially COVID itself or vaccination can trigger LS or a flare. I have seen many patients present with LS and recount having had COVID and a few months later develop the disease. There also seems to be a familial component (i.e. many different members of a family can be affected).
From the literature,
- Women tend to have at least one other autoimmune condition.
- 42% of women have autoimmune antibodies.
- Trauma and chronic irritation are causative factors.
- Low testosterone can precipitate it.
- Traditional treatment is clobetasol or tacrolimus…
- PRP can regenerate and heal tissues and turn down the immune system. Often used by Dr Charles Runels and his group and also cited here https://pmc.ncbi.nlm.nih.gov/articles/PMC5960026/
- Femilift, a CO2 laser has been used for LS which can increase and improve the production of collagen and elastin fibers in the dermis leading to enhanced stretchability and pliability of vulvar vaginal tissue.
- Combo therapy of PRP and Femilift. Used by Dr M Goodman and Dr Elias Jorge can be extremely helpful.
- I developed a protocol that I have started to use called the “LS protocol“ that uses energy-based treatment with regenerative ones. In the study I used Exion radiofrequency microneedling with Emfemme 360 and Exosome or PRP. https://oaskpublishers.com/assets/article-pdf/regenerative-approach-for-lichen-sclerosus-a-case-series-combining-monopolar-and-fractional-rf-therapy-with-biologics.pdf
Outcome of the Study
All patients participating in the study felt their LS was more under control and quickly after using Dr Shari Caplan’s study protocol, they clinically had much less disease. Their LS no longer interfered with their daily life, they were more present, and they had significant improvement in their symptoms. No more burning, itch or pain, tears healed. Most who were sexually active felt their pain and dryness was significantly reduced and that sex became pain free and many who couldn’t have sex were able to resume sexual activity. These results speak for themselves as shown on one of patients during her testimonial in our clinic.
LS can be so devastating. Women often tell me that it affects every aspect of their life. That they feel they can’t always be present because it’s always on their mind. It robs them of their sexuality, and confidence. It causes pain and itch. Treating then and preserving their anatomy and helping them maintain their intimacy is of the utmost importance for their general wellbeing. I tend to have a comprehensive approach where an in-depth history is taken to look for other signs of auto-immunity, incidental stress or hormone shifts, infections. I rule out co-infections like chronic yeast, BV, ureaplasma, UTI. I often recommend avoiding gluten as it contributes to leaky gut, I correct any underlying nutrient deficiency and replace deficient hormones.
See below’s a patient’s testimonial after being treated with the LS protocol created by Dr Caplan and her holistic approach.
“I’m so happy to be a part of the LS study I am a convert to Dr. Caplan’s treatment methods. I am forever grateful to you, Dr. Caplan and the whole team.”
How were you feeling before LS treatment?
Before receiving the LS treatment, I was feeling embarrassed, hopeless, depressed and anxious. Since being diagnosed in 2022 I have seen two local gynecologists and one not so local vulvar specialist, all of whom told me to keep applying Clobetesol and sent me away. I was itchy and was noticing structural changes even while watching my diet. I would get micro-tears just from wiping. I advised my gyno that I felt the steroid ointment was thinning my skin, which has always been sensitive, and I was dismissed.
Until seeing Dr. Caplan and her team I didn’t realize just how bad things had gotten with my LS. None of the three gynecologists I saw noticed fusing to my clitoris. The skin on my labia minora was tight and white.
How was LS impacting your quality of life and sex life?
My LS was never not on my mind. It was all consuming. As a mom of two young kids, I wasn’t able to be present with them or enjoy the small moments. LS robbed me of my sexuality. Just when I was feeling ready to become more sexual after the birth of our second daughter, anytime we tried it was excruciating, so we stopped. It affected my relationship with my husband negatively, my daughters, everyone. I was afraid to eat anything based on anecdotes from other LS sufferers saying that all the foods I loved (spinach, beets, raspberries, etc…) were high in oxalate and to avoid them at all costs.
How are you feeling now?
Since the treatments, the itchiness has drastically reduced. I typically only feel minor itchiness around my menstrual cycle. The treatments brought back the pink colour and plumpness to my labia and the surrounding area. I haven’t torn since having the treatments, and the skin as a whole is much healthier.
How is your quality of life and sex life improved?
My quality of life has improved tenfold! For the first time since being diagnosed (which took me to dark places), I feel a sense of hope and am able to be present with my children. I haven’t used clobetasol since three weeks before my initial treatment and I am doing significantly better than I was when I was using the steroid route. As far as my sex life, I am able to use the largest dilator with ease and am very hopeful that I’ll be able to properly come together with my husband. I plan on returning quarterly or biannually to maintain the results achieved long term. Again, I can’t speak highly enough.
LS can be a devastating disease and sometimes steroids aren’t enough. We should know what options are out there as we can have a huge impact on a women’s life. This is detailed in our published case series.
See the full research findings
