Can lichen sclerosus or lichen planus cause painful sex?

Lichen sclerosus and lichen planus are distinct but related chronic inflammatory skin conditions that predominantly affect the genital area. Both create long-term changes to the vulval architecture, turning healthy, elastic tissue into fragile, scarred skin. The result is a cycle of pain, avoidance of intimacy, and psychological distress that extends far beyond the physical symptoms.

Painful sex is not a minor inconvenience with these conditions. It is a primary symptom that significantly impairs quality of life and intimate relationships. The inflammation causes the vaginal opening to narrow, tissues to tear easily, and nerves to become hypersensitive. Many women describe the pain as burning, tearing, or like being cut with glass. For some, penetration becomes entirely impossible.

How Lichen Sclerosus Causes Dyspareunia

Lichen sclerosus primarily affects the vulva, creating characteristic white, thin patches of skin with a wrinkled appearance often described as resembling cigarette paper. The condition causes the tissues to become fragile and prone to splitting.

• Structural Changes: Over time, the labia minora can disappear entirely, the clitoris becomes buried under its hood, and the vaginal opening shrinks. This architectural distortion directly prevents comfortable penetration.
• Fissures and Erosions: The weakened skin tears easily during any friction, including sexual activity. These painful cracks bleed and take time to heal, making subsequent attempts at sex even more distressing.
• Introital Stenosis: The narrowing of the vaginal entrance is a common late-stage complication. This physical barrier makes penetration mechanically difficult or impossible without causing severe pain.
• Impact on Sexual Function: Studies confirm that between 55% and 75% of women with lichen sclerosus report dyspareunia, with many avoiding sex altogether. The psychological toll includes anxiety, body image concerns, and relationship strain.

How Lichen Planus Causes Dyspareunia

Lichen planus affecting the vulva and vagina is typically the erosive variant, which is more aggressive and painful than lichen sclerosus in many cases. It causes raw, open sores and severe inflammation.

• Erosive Disease: Lichen planus creates painful ulcers and erosions on the vulva and inside the vagina. These raw areas are exquisitely tender, and any touch or pressure causes intense burning and stinging pain.
• Desquamative Vaginitis: This form of inflammatory vaginitis accompanies erosive lichen planus. The vaginal lining sloughs away, creating a thick discharge and bleeding on contact. Examination alone can be unbearable, let alone intercourse.
• Vaginal Adhesions: Untreated or severe lichen planus can cause the vaginal walls to stick together, progressively narrowing or even completely closing off the vagina. This is a medical emergency requiring surgical intervention.
• Post-Coital Bleeding: The fragile, inflamed tissues bleed easily during or after sex, which is both distressing and a warning sign that the condition is active and damaging.

The Psychological Dimension of Sexual Pain

Chronic dyspareunia is not only a physical issue. It profoundly affects mental health, self-esteem, and intimate relationships.

• Fear-Avoidance Cycle: Repeated painful experiences create anticipatory anxiety. Even thinking about sex triggers muscle tension in the pelvic floor, which worsens pain and creates a vicious cycle.
• Identity and Shame: Many women report feeling inadequate as partners or broken as women. The visible changes to the vulva can cause embarrassment and reluctance to seek intimacy.
• Relationship Strain: Partners may feel rejected or confused. Without open communication and appropriate support, relationships can deteriorate, adding further emotional burden.