A skin dis­ease that can dis­rupt a sex life

The Tribune (SLO) - - Classifieds - BY JANE E. BRODY

You’ve prob­a­bly heard of lichens, com­plex or­gan­isms con­sist­ing of a fun­gus and an alga (and some­times a bac­terium) that break down rocks to cre­ate soil.

Though lichens vary widely in color and form, most of­ten seen are the white crusty va­ri­eties that col­o­nize the sur­face of trees, rocks and bar­ren soil. This type has lent its name to a lit­tle-known skin dis­ease — lichen scle­ro­sus — that typ­i­cally man­i­fests as white crusts on gen­i­tal tis­sues and is of­ten undiagnosed or mis­di­ag­nosed be­fore it wreaks havoc on peo­ple’s lives.

A re­lated dis­or­der, lichen planus, more of­ten af­fects the skin and in­side of the mouth but can also af­fect gen­i­tal mem­branes, where it can be more chal­leng­ing to treat than lichen scle­ro­sus.

Although lichen scle­ro­sus can form on any skin sur­face, it has a predilec­tion for a woman’s vulva and, less of­ten, a man’s pe­nis, and it can so dis­rupt peo­ple’s sex lives that di­vorce or celibacy is some­times the out­come.

Lichen planus gen­er­ally has broader tar­gets, but an ero­sive form can af­fect the anal-gen­i­tal re­gion and other body parts and be as de­struc­tive as lichen scle­ro­sus. In ad­di­tion to pain, both con­di­tions can cause in­tense itch­ing that, lack­ing an ac­cu­rate diagnosis, pa­tients may mis­treat with creams and other sub­stances that only make mat­ters worse. Doc­tors, too, may mis­take the prob­lem for a yeast infection and pre­scribe the wrong treat­ment.

Fur­ther­more, peo­ple rarely talk freely about dis­eases that at­tack the vulva or pe­nis, even to their doc­tors, which de­lays a cor­rect diagnosis and ef­fec­tive treat­ment. But even when pa­tients over­come their em­bar­rass­ment, they of­ten run up against med­i­cal ig­no­rance and mis­treat­ment un­til af­fected tis­sues be­come ir­repara­bly scarred.

“When gynecologists do a pelvic exam, they may not even look at the vulva,” said Dr. Anuja Vyas, a gy­ne­col­o­gist at Bay­lor College of Medicine who spe­cial­izes in these dis­or­ders. “Doc­tors of­ten treat the vulva like a small Mid­west­ern town that you drive through with­out notic­ing it.”

And when a woman past menopause com­plains that vagi­nal pain has made in­ter­course im­pos­si­ble, doc­tors may dis­miss it as nor­mal age-re­lated changes and miss the pres­ence of a treat­able dis­ease, she said.

Thus, it is of­ten up to pa­tients to make sure they get to a knowl­edge­able health care provider and get treat­ment that re­lieves symp­toms and halts pro­gres­sion of their dis­ease.

As two nurse prac­ti­tion­ers, Nicholas Wedel and Laura John­son, pointed out in The Jour­nal of Nurse Prac­ti­tion­ers, “Vul­var health is one as­pect of women’s health that is of­ten not dis­cussed,” even though “up to 20% of all women will ex­pe­ri­ence sig­nif­i­cant vul­var symp­toms at some point in their lives.”

Yet, they added, “when left un­treated, vul­var lichen scle­ro­sus can cause sig­nif­i­cant phys­i­cal, emo­tional and sex­ual dis­com­fort.”

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