From bestselling author and winner

of the People’s Choice Award

Lichen
Sclerosus
How to heal it
“at last...
a doctor who understands
how to treat Lichen Sclerosus”

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 Lichen Sclerosus - How to heal it
By Sandra Cabot MD

Published by SCB International Inc.

2027 W Rosegarden Lane Phoenix AZ. USA
Phone: 623 334 3232
www.liverdoctor.com

© Copyright by Sandra Cabot 2017

Updated in 2021

ISBN 978-1-936609-50-5
HEA039070 HEALTH & FITNESS / Diseases / Genitourinary & STDs
HEA039130 HEALTH & FITNESS / Diseases / Skin
MED033000 MEDICAL / Gynecology & Obstetrics

Disclaimer

The information provided in this publication is for informational purposes only

and is not intended as a substitute for advice from your physician or other
health care professional You should not use the information in this brochure
for diagnosis or treatment of any health problem or for prescription of any
medication or other treatment. You should consult with a healthcare professional
before starting any diet, exercise or supplementation program, before taking any
medication, or if you have or suspect you might have a health problem.

These statements have not been evaluated by the Food and Drug
Administration.

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publishers prior consent, in any form of binding or cover, other than that in which
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or otherwise, without the prior written permission of the copyright owner.

All rights are reserved by the publisher.

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Contents

1. Lichen sclerosus – How to heal it . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2. What causes lichen sclerosus? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
What does NOT cause lichen sclerosus? . . . . . . . . . . . . . . . . . . . . . 8
Appearance of lichen sclerosus . . . . . . . . . . . . . . . . . . . . . . . . . . 8
What are the possible symptoms of lichen sclerosus? . . . . . . . . . . . . 9
3. Case studies: Lichen sclerosus . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
First case study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Second case study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
How does a doctor diagnose lichen sclerosus? . . . . . . . . . . . . . . . . 14
Useful blood tests in a patient with lichen sclerosus . . . . . . . . . . . . 14
4. What other conditions can cause similar symptoms to lichen sclerosus? . . . 19
Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Lichen planus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Atrophic changes of the vulva after menopause . . . . . . . . . . . . . . . 20
Vitiligo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Human papilloma virus (HPV) . . . . . . . . . . . . . . . . . . . . . . . . . . 22
5. Treatment of lichen sclerosus . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Aims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
6. Drug treatment of lichen sclerosus . . . . . . . . . . . . . . . . . . . . . . . . 25
Initial treatment with steroid ointments or creams . . . . . . . . . . . . . 25
Benefits of steroid creams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Maintenance treatment with steroid creams . . . . . . . . . . . . . . . . . 27
Side effects of steroid creams . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
General advice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Soothing and healing creams . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
7. Nutritional medicine for lichen sclerosus . . . . . . . . . . . . . . . . . . . . 29
Gut and liver health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
8. How can we improve your gut health? . . . . . . . . . . . . . . . . . . . . . 31
Maintain a healthy population of microorganisms in your bowel . . . . 31
Probiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

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9. Recommended supplements to heal skin affected by lichen sclerosus . . . . 37
Vitamin D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Zinc supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Vitamin A supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Vitamin E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Selenium supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
N-Acetyl Cysteine (NAC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Glutamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
10. Hormone treatment in women with lichen sclerosus . . . . . . . . . . . 42
How the hormones work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
11. Gluten sensitivity – Could it be an issue in lichen sclerosus ? . . . . . . . 45
Elimination diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
12. Your diet and lichen sclerosus . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Ingredients to juice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
13. Other treatments for lichen sclerosus . . . . . . . . . . . . . . . . . . . . . 49
Treatments that do not heal lichen sclerosus . . . . . . . . . . . . . . . . . 49
Surgery for lichen sclerosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Platelet-rich plasma (PRP) – A novel treatment for lichen sclerosus . . . 50
14. Bacterial vaginosis and vaginal odor . . . . . . . . . . . . . . . . . . . . . . 51
Tests that can be done for diagnosis of bacterial vaginosis . . . . . . . . 51
Drug treatment for bacterial vaginosis . . . . . . . . . . . . . . . . . . . . . 52
Naturopathic treatment approach for bacterial vaginosis . . . . . . . . . 52
Vaginal douching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
15. Your sex life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Causes of poor libido . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
How can we help the libido? . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Painful sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
What can cause pain in the vulva? . . . . . . . . . . . . . . . . . . . . . . . . 59
16. Cancer of the vulva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
What causes cancer of the vulva? . . . . . . . . . . . . . . . . . . . . . . . . 60
How can we test for cancer of the vulva? . . . . . . . . . . . . . . . . . . . 61
Prevention of cancer of the vulva . . . . . . . . . . . . . . . . . . . . . . . . 61
17. Get lichen sclerosus treated early . . . . . . . . . . . . . . . . . . . . . . . . 63

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1. Lichen sclerosus – How to heal it

The term lichen sclerosus is pronounced lyken sclurosus. This

condition sounds serious but is not to be confused with more
serious diseases with similar names such as scleroderma or
multiple sclerosis.
Although lichen sclerosus is not a very serious health problem
in that it does not affect the whole body, it is one of the
most distressing problems that can befall a woman. This is
because it attacks your genital areas and is a threat to your
self-esteem and sex life. It is awful to go through life with a
horrible discomfort, which makes you want to scratch yourself
down there all the time. It can make you feel unsexy and
unattractive and just plain uncomfortable and you will think
“why me?” I don’t deserve this awful discomfort which is so
embarrassing and distracting. It’s hard to understand why
this inflammation is attacking you and threatening to disfigure
the most private and sensual area of your body. You may feel
helpless and anxious because you don’t know how to express
yourself to your doctor, family or sexual partner. You may feel
dirty or contaminated believing wrongly that you are suffering
with an infection such as Candida or some nasty bacteria. This
is not the cause of the discomfort and itch in lichen sclerosus.
Lichen sclerosus is not contagious or transmissible to your
partner or family. It is often misdiagnosed as thrush, Candida
or dermatitis, so that the pain and discomfort is not treated
correctly for many years. This is sad as it can be effectively
treated, especially if diagnosed early.

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2. What causes lichen sclerosus?

Lichen sclerosus (LS) is an autoimmune disease where your

immune system attacks the tissues in your vulva and/or
perineum; thus, it is caused by a problem with your immune
system.
You can control lichen sclerosus and prevent it from destroying
your womanhood. Modern day medicine can effectively control
the symptoms and suppress the inflammation, but it does
not address the cause. I have been able to help many women
treat the cause of lichen sclerosus by improving their immune
system with nutritional medicine. Don’t have any doubt that
nutritional medicine is powerful enough to help your own
immune system stop this awful inflammation dead in its tracks.
It’s very logical and scientific, as we can treat the cause and
thus stop the disease process. What a relief to millions of
women who suffer with this relatively common condition.
Lichen sclerosus is classified as a persistent and long-
lasting (chronic) disorder affecting the skin in the vulva and/
or perineum. The affected skin is deeply damaged by the
inflammation occurring in the superficial and deeper layers of
the skin.

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The cause of LS is chronic inflammation in the top and deeper
layers of the skin.
This abnormal inflammation is caused by a problem with the
way your immune system functions. The inflammation serves
no useful purpose and is a sign that your immune system is
attacking your skin. This is abnormal, as a healthy immune
system protects you against many toxic and infectious agents.
The process where your immune system attacks your body
instead of protecting, is called autoimmune disease.
LS can be considered a type of autoimmune disease in that
your immune system is attacking your vulva. If you have LS,
you are more likely to have a family history of autoimmune
diseases or to suffer with other autoimmune diseases yourself.
These include thyroid problems, alopecia, pernicious anemia,
celiac disease or inflammatory arthritis.
There may be a family history of LS. In other words, it can run
in families. There may be a family history of other types of
autoimmune diseases.
LS can affect both men and women. Men can have LS on their
genitals and anus.
The treatment of LS in men is the same as in women, and the
recommendations in this book (except for the use of female
sex hormones) can be used by men to get the same benefits.
General health and lifestyle factors can make lichen sclerosus
much worse.
Things that can trigger flare ups of LS include:
• infections in the vagina or bowel
• unhealthy bacteria in the bowel (dysbiosis)
• food intolerances and allergies, especially to gluten
• very low estrogen levels after menopause
• deficiencies of vitamin D, vitamin A, zinc and selenium which
are common
• stress

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• insomnia
• a high dietary sugar intake and/or diabetes
• smoking
• alcohol excess
To overcome LS, we must treat the immune system and the
digestive tract and not just suppress the symptoms.

What does NOT cause lichen sclerosus?

• LS is NOT self-inflicted by excess scratching or excess use of
soaps or personal hygiene products.
• LS is NOT an allergy to underwear or personal products.
• LS is NOT an infection and thus is not contagious. You
cannot pass it on to your sexual partner or family members.
However, LS is often misdiagnosed as various infections,
especially Candida albicans, which is a yeast.

Appearance of lichen sclerosus

Lichen sclerosus can present as white and pink patches,
cracks, fissures and small ulcers on the skin of the lips of the
vulva and perineum.
It may appear as ivory white and pink patches, which are
irregular in shape. The affected skin may become thick and
tough and/or thinned out. If the inflammation is deep, open
sores (ulcers) and deep cracks may develop in the skin. LS
may affect only the vulva in the areas of the labia (lips of the
vulva) and clitoris, but can also affect the perineum. The labia
may become distorted and flattened and gradually shrink. The
clitoris may become so inflamed and scarred that it shrinks and
becomes hard to find.
Lichen sclerosus can affect skin on other parts of the body and
not just the vulva.
It can affect the skin around the anus causing severe itching,
bleeding and cracking, which makes it hard to pass a bowel
action. LS can affect the skin of the groins and buttocks.
LS does not go high up inside the vagina and the mucous

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membrane lining the inside of the vagina usually looks normal
on examination.
The affected tissues can be eaten away by the inflammation,
so that permanent scarring results. The clitoris and the
vulva may be gradually eaten away and destroyed by the
inflammation so that the area becomes disfigured. If the
inflammation is not controlled, the affected areas may be
susceptible to cancer cells developing with a long-term result
of cancer of the vulva or vagina.

What are the possible symptoms of lichen sclerosus?

Itch – this is the most frequent symptom and can be severe
and constant or intermittent and made worse by high
temperatures.
Burning, discomfort, pain and tenderness in affected areas in
the vulva, perineum and anus.

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Discharge - there may be a slight discharge, which can
be blood-stained from broken skin and cracks caused by
inflammation and scratching.
Painful intercourse, especially if there are cracks or ulcers in
the vulva and/or in the skin around the vulva.
There may be no symptoms at all and the LS is first picked up
by the doctor doing a routine gynecological checkup. Even if
there are no symptoms, the disease can be active and cause
scarring and tissue destruction.
The symptoms can begin at any age - from childhood to old
age. Age is an important predisposing factor and the disease
tends to show itself and get worse in women in their forties
and beyond. LS can start before puberty.

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3. Case studies: Lichen sclerosus

For many women, the subject of vaginal health is a difficult

one to broach, especially if they have embarrassing or chronic
problems down there. It may be harder if you have a male
doctor, but thankfully there are many female gynecologists and
family doctors these days, which makes it easier.

First case study

Recently I saw a 44-year-old woman who had suffered with
lichen sclerosus of the vulva and perineum for over a decade.
She had seen many doctors, including gynecologists and skin
specialists (dermatologists), whose strategy was to suppress
the inflammation with cortisone (steroid) creams. The most
helpful doctor she had seen to date was a holistic doctor who
had picked up that she had intolerance to gluten. She had
followed this doctor’s advice to avoid all gluten-containing
foods and had noticed a huge improvement in her symptoms.
However, as is prone to occur, high stress levels reoccurred,
causing her to become less vigilant with her diet and she
started eating gluten and excess sugar again and put on
weight. Of course, her lichen sclerosus flared up!
I told this woman that I could help her control this severe
disease with a holistic program to balance her hormones and
immune system.
My program included:
• Natural progesterone cream to rub into her inner upper
thigh once daily. Progesterone is not only effective in
reducing heavy menstrual bleeding, it is also a natural anti-
inflammatory and immune modulator. It’s such a pity that
it’s not used more often! The starting dose is one gram of a
5 to 10 percent strength cream daily. The hormone is well
absorbed through the skin into the circulation.
• Vitamin D 5000 IU daily with food. Her blood vitamin D
level was very low. Vitamin D is a natural anti-inflammatory

11
 substance and is really a hormone and not a vitamin. Once
her blood vitamin D levels were back into the high end of the
normal range, the dose would be reduced to keep her levels
above 100 ng/mL.
• Selenium – which is an immune modulator with powerful
anti-inflammatory and anticancer properties. Selenium is
vitally important to consider in all cases of autoimmune
diseases.
• Extra supplements recommended included vitamin A, liquid
fish oil and zinc to reduce inflammation and promote
healing.
• A daily probiotic to repopulate the intestines with healthy
bacteria. Fermented foods such as kefir, organic apple
cider vinegar, miso and sauerkraut etc. to promote healthy
bacteria in the intestines. I did emphasize that she should
continue to avoid all gluten-containing foods.
• To protect the ulcerated and cracked areas in the vulva,
I recommended she use a combination cream containing
castor oil and zinc during the daytime.
• To renew and strengthen the tissues of the vulva and
perineum, I recommended a hormonal cream containing
1.0 mg of a bioidentical estrogen called Biest and 2.0 mg of
testosterone. This was to be used at night and one gram of
the cream was to be rubbed into the affected areas of the
vulva and perineum.
• To suppress itch and inflammation, I prescribed a steroid
cream called Betnovate to be applied to affected areas once
daily until symptoms cleared up. She would then only need
this steroid cream twice a week or approximately every 3 to
4 days.
I also asked this patient to see her gynecologist regularly, as
he specialized in lichen sclerosus and could check the affected
areas every 12 months to pick up any areas suspicions for
cancerous changes, which can be biopsied and sent for
pathology testing.

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I did reassure her that the program I recommended would
work very well and that she could look forward to a major
improvement of her problem, so much so, that she should
be able to have a normal healthy sex life, as well as good
general health. This level of improvement occurs gradually and
full benefits are seen after 6 to 12 months. By following my
program, she would also be much less at risk for autoimmune
disease to attack other parts of her body.

Second case study

Women of all ages can suffer with awful discomfort down
there. The other day, I saw a delightful elderly woman in her
80s who had suffered with a burning pain in her vagina and
vulva for many years. She had not found much relief by using
cortisone creams prescribed by her local GP and gynecologist.
Thankfully for this elderly woman, I was a female doctor and I
could take a good look and do a thorough examination. I found
she had atrophic vaginitis caused by a severe lack of estrogen,
as well as some patches of lichen sclerosus on her vulva. It’s
incredible to think that the effects of menopause can last so
long that they still cause us suffering in our advanced years.
I was confident that I could help this poor woman who was
driven mad by the burning and itching discomfort down there.
I prescribed a cream containing bioidentical hormones
consisting of estriol, estradiol, progesterone and testosterone.
In most countries, this type of hormonal cream has to be
prescribed by a doctor and made up by a compounding
chemist. These hormones would improve and strengthen the
tissues in her vagina and vulva, making them comfortable and
resistant to infections from bacteria and Candida. She was to
apply this cream to the vulva every night. In the mornings,
I told her to apply a cream containing a steroid mixed with
castor oil and zinc cream to the tender itchy areas. After 6
weeks, she was no longer in pain and the itch had gone. She
continued this treatment for several years without any side
effects.

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How does a doctor diagnose lichen sclerosus?
Biopsy of the affected area – A very small amount of tissue
is removed and sent to a pathology laboratory, where it is
examined under a microscope by a pathologist who looks at
the appearance of the tissue.
The pathologist will see the following changes in the biopsied
tissue:
• Upper layer of skin (epithelium) appears thickened, but
there may be thinned out areas as well.
• Underneath the upper skin layer, the tissue looks depleted
with a loss of cells and this area looks swollen with fluid.
There is a loss of the normal collagen, elastic fibers in this
area and there is a lot of scar tissue, which explains why the
affected areas feel stiff and spongy
• Even deeper in the tissues, is an area of severe inflammation
with a layer of excessive white blood cells that are attacking
the normal cells of the deeper layers of the skin.
Sometimes the biopsy may not give a definite or accurate
result, especially if the LS has been present for many years. In
such cases, it has become “burnt out” and there may be too
much damage. It is best to biopsy before beginning treatment,
as treatment may change the appearance of LS. The biopsy
only samples a small part of the total affected area and may
miss the best areas to show the classic cell and tissue changes
of LS. Thus, the doctor must decide if the appearance to their
naked eye or with magnification is typical of LS. In such cases,
even if the biopsy is negative or inconclusive, the problem
should be treated as LS.

Useful blood tests in a patient with lichen sclerosus

Hormones
Hormone levels in the blood are worthwhile checking, although
they are a general guide only. This is because it is still
important to use a hormone cream to get a local hormone
effect on affected area, regardless of what blood hormone

14
levels show. I always use a hormone cream on affected areas,
even in young and premenopausal women, because it always
helps.
Blood levels of the hormones FSH, estradiol, free testosterone
and total testosterone and progesterone should be measured.
If the FSH is above 40 and the estradiol level is below 100, this
indicates a postmenopausal state and very low sex hormone
levels. These low sex hormone levels will make LS much
worse.
Vitamin D levels
Vitamin D levels should be measured and if low, supplements
must be given to help the immune system and reduce
inflammation.
Vitamin D is a fat-soluble vitamin that requires fat in the
diet and a healthy gut to be absorbed in adequate amounts.
Vitamin D is not really a vitamin and has now been correctly
classified as a hormone that regulates hundreds of our genes
to keep our immune system healthy. It is also different from
all other nutrients because it is mostly made in our body from
UVB light produced by the sun. Most gluten-intolerant people
are very low in vitamin D and this makes their inflammation
much worse. Vitamin D deficiency also leads to premature
or severe osteoporosis and this is common in people with
undiagnosed gluten intolerance.
It is vitally important to ask your doctor to check your blood
level of vitamin D. The correct blood test is called 25(OH) D,
also called 25-hydroxyvitamin D3.
The most important factor is your vitamin D serum level. It
doesn’t matter how much time you spend in the sun, or how
much vitamin D3 you take, if your blood level is low, then
you’re at an increased risk of autoimmune diseases such as
lichen sclerosus, cancer and osteoporosis.
Vitamin D can be measured in two different units of
measurement. In the USA, the units used are ng/mL. In
Australia and Canada, the units of measurement are nmol/L.

15
The normal ranges of vitamin D for blood tests reported by
different laboratories and countries vary significantly and you
will be surprised by the large range between lower normal and
upper normal (see table below).

Lower Limit Vitamin D Upper Limit Vitamin D

75 nmol/L 200 nmol/L
30 ng/mL 100 ng/mL

You don’t want to be average here. You want to have levels of

vitamin D that optimize your immune system and the optimal
levels of vitamin D are higher than the average levels.
Other blood tests
A full blood count and liver function should be done to check
the immune system.
Markers of general body inflammation such as CRP and ESR
should be measured to get a baseline level. Fasting blood
sugar levels should be checked as diabetes or prediabetes can
cause infections which aggravate LS.
Vaginal tests
Acidity of vaginal fluids - For optimal health of the vagina
and vulva, the acid-base balance of the vaginal secretions/fluid
needs to be slightly acidic. The measurement of how acidic or
alkaline a fluid is, is called the pH and is represented as a scale
from 1 to 14. The lower the pH, the more acidic the fluid is. A
pH of 7 is neutral, meaning neither acid or alkaline. A normal
healthy vagina has a pH range of 3.5 to 4.5, which is acidic,
but not too acidic. The vaginal pH can be measured with a
special paper stick placed against the lower wall of the vagina
for approximately one minute.
An acidic vaginal pH keeps bad bacteria under control, as they
prefer to grow in an alkaline environment. A healthy vagina
has a preponderance of lactobacillus, which thrive in an acid
pH. Lactobacilli keep the vagina healthy and reduce unhealthy

16
secretions that may irritate the vulva and cause offensive odor
and itch.
After menopause, the lactobacilli become much less in
numbers, unless hormone therapy is given.
Swabs
A swab is taken of the vaginal secretions and is cultured and
genetically tested for bacteria, yeasts, chlamydia, gonorrhea
and other unhealthy bacteria.
Samples (swabs) are taken from the vagina, cervix and vulva
and tested for human papilloma virus (wart virus). This virus
can cause burning and itching of the vulva.
Urine sample
A midstream urine sample is tested. Microscopy of the urine
and sensitivity of bad bacteria to antibiotic drugs and also
biochemistry of the urine is done.
Pap test
The Pap test used to look for abnormal cell changes in the
cervix. The new Pap test looks for the human papilloma virus
(HPV) which can spread during sexual activity. The HPV can
cause precancerous and cancerous changes in the cervix. An
HPV vaccine is available, which protects against up to 9 types
of HPV, including those that cause the majority of cervical
cancers. Supplementing with selenium will reduce the risk of
HPV causing cervical cancer, because selenium has powerful
antiviral effects.
Scans
A pelvic and transvaginal ultrasound scan can accurately check
the size and shape of uterus and the ovaries. This scan can
detect ovarian tumors and cysts, which could be cancerous or
benign, and/or fibroids or a thickened lining of the uterus.
Physical examination
• Pelvic examination by the doctor to check the uterus and
ovaries, pelvic floor muscles, appearance of cervix, vaginal
walls, perineum and vulva.

17
• Colposcopy of cervix and vulva. A colposcope is basically
a magnifying lens with a very bright light, designed to
examine the cervix and vulva. During this easy procedure,
the cervix is swabbed with vinegar and this causes any
abnormal areas to turn white. These areas can then be
biopsied and sent to pathology to check for precancerous
changes. The areas of the vulva and perineum affected by
LS should be examined by a gynecologist, who is expert in
the treatment of vulval disorders, so that biopsies of the
affected areas can be done. A biopsy is the removal of a tiny
bit of tissue with a small punch-like cutter and the sample
of tissue is sent to a pathology laboratory to be examined
under a microscope. The microscopic examination allows the
accurate diagnosis of LS, as well as excluding any cancerous
changes in tissues affected by LS. A biopsy is a quick office
procedure and is not very painful.

18
4. What other conditions can cause
similar symptoms to lichen sclerosus?

This is called the differential diagnosis and excludes other

conditions that may appear to be LS, but are not LS.

Eczema
Eczema is also called dermatitis and is an inflammatory
condition of the skin, which can affect any part of the skin.
It manifests as a red and dry, itchy rash, especially in the
flexures of the elbows and knees and may be widespread.
Eczema is more of an allergy or sensitivity, and unlike LS, it is
not an autoimmune disease. Eczema is often hereditary and
associated with allergies to foods such as gluten, dairy and
preservatives and a significant percentage of eczema patients
have other allergic conditions, such as asthma or hay fever.
The inflammation in the skin is not as deep as it is in LS and
does not cause destruction of the deeper layers of the skin.
Eczema of the vulva and perineum does not cause scarring or
destruction of the tissues in the vulva. Treatment of eczema
includes a diet free of gluten, preservatives and dairy products
and supplements of probiotics, omega 3 fatty acids,
selenium and zinc. Steroid creams provide symptomatic
relief.

Lichen planus
This skin disorder can affect the mucous membranes in the
mouth, the esophagus, the stomach, the eyes, the bladder,
the vulva and the anus, as well as the skin on different parts
of the body. Thus, there may be lesions in the mouth, on the
skin, on the vulva and in the vagina, all at once. Affected areas
of the vulva and vagina show erosions, which are very red in
color. These erosions may have a white border. It can appear
as white spider, weblike areas spotted with red erosions. It
may spread so that the whole vagina appears red raw. The
amount of inflammation in lichen planus is very severe and

19
this may result in scarring and flattening of the labia. One big
difference between lichen sclerosus and lichen planus is that
lichen sclerosus only affects the vulva, whilst lichen planus
affects the vagina as well. Lichen planus may cause severe
inflammation inside the vagina, which may result in bleeding
and vaginal discharge. The discharge can be yellow-green and
blood-stained.
The main symptom of lichen planus is itching, so it can be
confused with lichen sclerosus. However, there is often a lot
more pain with lichen planus with burning and stinging and
sharp pains. Sexual intercourse may become impossible.
Lichen planus is much less common than lichen sclerosus. It is
vital to examine the skin and the mouth to see if lichen planus
is present in these areas.
Lichen planus is an autoimmune disease, where the immune
system makes antibodies against the cells of the affected
person’s skin and mucous membranes.
Lichen planus will usually respond well to the same natural
therapies that I discuss for the healing of lichen sclerosus.
Steroid ointments will be used, as well to get the inflammation
under control.

Atrophic changes of the vulva after menopause

The loss of the sex hormones estrogen, progesterone and
testosterone causes the tissues of the vagina and vulva to
shrink and thin. This is known as atrophy. The clitoris and
lips of the vulva can shrink to a large degree without the sex
hormones.
The vulva becomes more fragile, thinner and paler. The pH
becomes more alkaline, which can allow unhealthy bacteria
to flourish. The post menopausal vulva and vagina may feel
uncomfortable and many women experience a burning, itching
and tender feeling. The loss of sex hormones after menopause
does not cause LS, but can make it worse.

20
 Comparison illustration of a healthy vagina and a vagina displaying atrophy

Urinary tract infections may become more common, as the

loss of estrogen causes thinning of the base of the bladder
and urethra. Estrogen cream and a regular supplement of
D-Mannose & Cranberry capsules and a regular vitamin C
supplement can prevent most urinary tract infections.
The atrophy and dryness of the vulva and vagina make sexual
intercourse uncomfortable, as lubrication is unable to occur.
This can be overcome and reversed by the application of a
cream containing the hormones estrogen, progesterone and
testosterone. This cream is massaged into the vulva and
clitoris once daily and restores the tissues back to their healthy
state that existed before menopause. This cream improves
the libido, restores sensitivity, increases the size of the clitoris
and enables normal sexual intercourse to occur once again.
This repair of the vulva can occur within several weeks. This
hormone cream relives all the symptoms of burning, itching
and dryness.

21
Vitiligo
Vitiligo is a loss of pigmentation of the skin leading to white
areas. This is an autoimmune condition. There is no itching or
redness of affected areas and unlike LS, there is no destruction
of the skin or structures of the vulva.

Psoriasis
If psoriasis affects the vulva, it is called plaque psoriasis.
Psoriasis looks different to LS and appears as thickened, scaly
areas with colors varying from red, purple to silverlike streaks.
It is often hereditary and the rash can affect large areas of the
skin on the limbs, trunk and abdomen and not just the vulva.
Unlike LS, with psoriasis there is no destruction of the skin or
structures of the vulva.

Human papilloma virus (HPV)

The human papilloma virus (HPV) is typically transmitted
through sexual contact. Human papilloma viruses infect
human cells (known as keratinocytes) of the skin or mucous
membranes. Some types of HPV will not cause any symptoms,
but other types can cause genital warts. If HPV infects the skin
of the vulva, it can cause an itching and burning sensation, but
the vulva usually looks normal. Unlike LS, the HPV does not
cause destruction and scarring of the tissues.
In a small number of cases, infection with the HPV can cause
cancers of the vulva, vagina, anus and cervix in women, or
cancers of the penis and anus in men. HPV infection is the
cause of nearly all cases of cervical cancer.
The HPV can cause warts to grow in the genital area. These
appear as soft, pink or flesh-colored swellings. Genital warts
vary in appearance. They can be flat or raised, small or large,
single or multiple, and sometimes appear cauliflower-shaped.
Genital warts can grow on the vulva, in or around the vagina
or anus and on the cervix.
Most HPV infections in young females are temporary and 70
percent of infections are gone in one year and 90 percent

22
after 2 years. In 5 to 10 percent of women, the HPV persists
causing a high risk of precancerous changes of the cervix.
This can progress to invasive cervical cancer. This progression
usually takes 20 years and can be detected with regular Pap
smears. Progression to invasive cancer can be almost always
prevented with proper treatment.
Precancerous changes in the vulva or anus can also occur with
an HPV infection. In rare cases, HPV infection results in anal or
genital cancers.
Swabs of the cervix and vulva can be tested for the HPV and
it is important to do these tests if you have a chronic itch or
burning sensation in the vulva or perineum.

23
5. Treatment of lichen sclerosus

Aims
It is vital to treat the cause of lichen sclerosus, which means
we need to balance the immune system and stop it from
attacking the tissues of the vulva. This will greatly reduce or
stop the inflammation, so that it does not damage the tissues
of the vulva or other affected areas. This can greatly improve
the appearance of the vulva. Early detection and treatment
greatly increase the chance of total healing, but lifelong
maintenance treatment will be required.
In most cases, lichen sclerosus can be well-controlled with a
combination of:
• steroid ointments and/or creams
• hormonal creams
• nutritional supplements
• dietary improvements
• stress management
These things must be used correctly or results will be
disappointing. The earlier LS is diagnosed and treated the
better. This may seem obvious, but an accurate diagnosis
is often delayed because the patient is not referred to a
specialist and continues to be treated by a generalist doctor
for the wrong condition. It is good to see a gynecologist who
specializes in diseases of the vulva, as not all gynecologists are
experts in LS.

24
6. Drug treatment of lichen sclerosus

Initial treatment with steroid ointments or creams

Initially, steroid ointments or creams are vital to get the
inflammation under control and provide relief to the patient.
A suitable steroid ointment is Clobetasol and is applied to
the whole area affected by the LS, once daily. The ointment
is more effective than the cream. Clobetasol, or other strong
steroid ointments/creams, can be used daily for up to 6
weeks. Thereafter, the ointment can be used every alternate
day for 6 to 8 weeks, then weekly long term. Treatment
must be continued for life or the disease will recur and
cancer of the vulva may occur. In untreated women with LS,
the incidence of cancer of the vulva is 3 to 5 percent or 1
in 20 to 1 in 33 women. This risk is quite high, so it is vital
to continue treatment and have regular examinations of
the vulva. Clobetasol is a super potent steroid and is 8,000
times stronger than weak hydrocortisone creams. Clobetasol
propionate is a corticosteroid used to treat various skin
disorders and belongs to US Class I of the corticosteroids,
making it one of the most potent available.
To enable the Clobetasol ointment to penetrate to the deeper
layers of the affected areas where it is needed, it is important
to soak the vulva and perineum in warm water for 15 to 20
minutes to soften the skin. This can be done in a bath or a
small pottie.
It is most important to rub the Clobetasol ointment thoroughly
into all affected areas. Just applying the ointment will not
work well, as it must be rubbed right into the deeper layers of
affected tissue.
In severe cases, the doctor may inject the deeper layers of
affected areas with steroid injections, just to get the LS under
control quickly.
Clobetasol propionate ointment is also used to treat several
other autoimmune diseases, including alopecia areata

25
(autoimmune destruction of hair follicles), vitiligo (autoimmune
loss of skin pigment cells) and lichen planus (autoimmune skin
nodules).
Clobetasol propionate is sold worldwide under numerous
names, including Clobex, Cosvate, Temovate, Olux, Tenovate,
Dermovate, Butavate, Movate and Novate.
Clobetasol propionate is for external use only and must be kept
out of the eyes. When using clobetasol propionate. some of it
may be absorbed through the skin and into the bloodstream.
Too much absorption may lead to unwanted side effects.
To minimize the problem, large amounts of clobetasol
propionate should not be used over large areas for extended
periods of time.
The most frequent adverse reactions reported for clobetasol
propionate ointment/cream are burning and stinging
sensations in 1 percent of treated patients. Less frequent
adverse reactions were itching, skin atrophy, and cracking and
fissuring of the skin. Allergic reactions to the cream are not
common.
Patients receiving super potent corticosteroids should not
be treated for more than 6 weeks at a time. Once relief is
provided, a weaker steroid cream, such as hydrocortisone
cream, can safely be used on a daily basis, if needed. However,
most experts recommend continuing treatment with once
weekly Clobetasol ointment.

Benefits of steroid creams

• Quick and marked relief of itching and discomfort
• Improved appearance of skin in affected areas
• Control of the destructive inflammation and preservation of
the tissues of the vulva
Note: In lichen planus, which can affect tissues inside
the vagina, the use of steroid vaginal pessaries (similar to
suppositories) may be easier, than trying to insert a steroid
cream into a painful vagina.

26
Maintenance treatment with steroid creams
Clobetasol ointment may be needed once or twice weekly. You
still need to soak the affected areas in warm water for 15 to
20 minutes before applying ointment. Make sure you rub the
ointment in well.
Less potent cortisone cream can be used in between this twice
weekly treatment, if itching or other symptoms occur.
See your doctor annually, as a minimum, to check the affected
areas.

Side effects of steroid creams

• Thinning of tissues may occur. However, some thinning is
desirable, as the skin affected by LS is too thick and tough
because it is full of scar tissue. This thinning will make
the skin softer and more flexible. Excess thinning is only a
problem if the strong steroid ointments are overused.
• Stretch marks or striae.
• Candida growth, as steroids suppress the immune system,
but this should not occur if you have a healthy diet and take
the correct supplements.

General advice
• Avoid irritants, such as antiseptic and deodorant creams and
sprays.
• Cold packs can lessen burning in the vulva.
• Loose underwear is desirable.
• Sitz baths can help to soothe the affected area. A sitz bath
or hip bath is a bath in which a person sits in water up to
the hips. It is used to relieve discomfort and pain in the
lower part of the body; for example, due to hemorrhoids
(piles), anal fissures and vulval itch. It works by keeping the
affected area clean and increasing the flow of blood to it.
• If the itching and burning sensation is very severe, topical
anesthetic gels or creams containing 5 percent lignocaine
can be used.

27
• If you have yeast or fungal infections, avoid oral antifungals,
as they are liver toxic. It is much safer to use antifungal
creams on affected areas. Ozonated oils applied to areas,
affected by bacterial or fungal infections, can help and they
must be kept in the refrigerator. Follow a sugar-free diet and
take a strong probiotic.

Soothing and healing creams

There are several soothing creams that can bring good relief
to the discomfort in the vulva and perineum, and they do not
have any side effects.
The time-honored, old fashioned Castor Oil and Zinc Cream is
quite effective and can be used liberally all over the affected
areas.
Other creams that can help to lubricate and heal the tissues
are:
• hemp oil or hemp oil cream
• vitamin E cream
• vitamin A cream
• cold pressed olive oil
• ozonated oils, if infection is present

28
7. N
 utritional medicine for lichen
sclerosus

Gut and liver health

With any autoimmune disease, and especially one like LS that
attacks skin close to the anus, we must work on our digestive
health. A large part of the immune system is found in the
intestines and consists of huge numbers of bacteria, which are
meant to be beneficial to general health.
These healthy bacteria:
• break down toxins, which would otherwise inflame the lining
of your intestines.
• keep the numbers of unhealthy bacteria low and under
control.
It is vital that you have many more of these healthy bacteria
in your intestines than unhealthy bacteria, otherwise your
intestines will become inflamed and excessively permeable, so
that toxins can be absorbed into the bloodstream from your
gut. These toxic products can be reabsorbed into the veins
around the intestines, which drain back to the liver and your
liver then has to work much harder to break them down. An
overworked liver leads to excess inflammation, which can
manifest as skin problems, such as LS. It is interesting to know
that inflammation in your intestines and liver can worsen skin
inflammation, as the liver is situated a long way from the site
of inflammation in your vulva and perineum. However, we must
improve your gut health if we are serious about overcoming
lichen sclerosus.

29
 mouth
liver
oesophagus

stomach

small intestine

colon gall bladder

small intestine

rectum

Inflammation in your intestines and liver can worsen lichen sclerosus

The Digestive Tract

30
8. How can we improve your gut health?

Maintain a healthy population of microorganisms in

your bowel
Your bowels may be harboring excessive populations of
unfriendly microorganisms, such as fungi (most commonly
yeasts, such as Candida albicans), bacteria, viruses and
parasites. The term parasite is used to describe a great
variety of creatures that vary in complexity; from single-
celled organisms, all the way up to worms that may be
several inches or longer. Common disease-causing parasites
are Giardia, Entamoeba histolytica and Cryptosporidium,
which can be difficult to detect with routine stool analysis and
cultures. When a stool specimen is examined in the pathology
laboratory for parasites, many of the yeasts that are seen are
already dead. Therefore, stool cultures often fail to reveal the
presence of fungi, even when the gut is heavily infected. Some
laboratories will examine repeated, fresh stool specimens
obtained after inducing mild diarrhoea with laxatives and this
will increase the chances of detection. The specialized tests
known as a “complete diagnostic stool analysis” (CDSA) and
fecal PCR can increase chances of detection.
A natural antiparasite remedy that can sometimes be quite
helpful is called Intestinal Parasite Cleanse and each
capsule contains:
• Wormwood flower and leaf (Artemisia absinthium)100 mg
• Black walnut green hull (Juglaris nigra) 100 mg
• Cloves (Syzygium aromaticum) 100 mg
• Garlic (deodorized from Alium sativum) 50 mg
• Butternut root bark (Juglaris cinerea) 50 mg
• Buckthorn bark (Rhamnus frangula) 50 mg
• Pau D’Arco (Trabebuia heptaphylla bark) 50 mg

31
The recommended dose is to take one to two capsules, up to
three times daily, just before food for 4 to 6 weeks.
There is also a capsule formula available containing a
combination of phellodendron, oregano, thyme and clove
essential oils, which can be prescribed by doctors and
naturopaths and is also available online. It is called Bacto
Clear and it acts as a natural antibiotic for the intestines and
also helps to reduce yeast overgrowth.
Antiparasitic remedies are often more effective if they are
followed by a purge, during which many dead parasites will be
expelled in the feces. To achieve the required laxative effect,
you can take 2 to 3 teaspoons of Epsom salts with 4 glasses of
water or fruit juice, two hours after finishing the antiparasitic
medication.
To reduce bowel infections with unfriendly bacteria, parasites
and yeasts:
• Avoid refined sugars and excess carbohydrates in the diet,
as they are the fuel for unhealthy microorganisms.
• Avoid preserved foods, especially preserved meats (pizza
meats, corned beef, ham, devon, bacon, sausage, smoked
meats and smoked fish etc.).
• Avoid moldy foods, such as old peanuts, green potatoes and
dried fruits that are moldy or bitter.
• Avoid the long-term or frequent use of antibiotic, anti-
inflammatory and oral steroid drugs, if possible.
• Eat plentiful fiber in the form of raw vegetables and fruits,
ground seeds (flaxseeds, pepitas) chia seeds and hemp
seeds, which do not have to be ground. This will have a
“broom effect” and sweep the walls of the colon clean,
removing layers of encrusted and hardened feces, which
harbor unfriendly microorganisms. Use a gluten-free fiber
powder regularly, such as FiberTone to cleanse the colon.
• Follow practises of good hygiene, such as sterilization of
kitchen towels and washers and frequent handwashing.

32
• Use natural antibiotics to reduce intestinal yeasts,
bacteria and parasites. Natural antibiotic foods, herbs and
condiments include cabbage juice, raw or fermented garlic,
onions, leeks, radishes, fenugreek, ginger, lemon juice,
organic apple cider vinegar, turmeric, mustard, oregano,
chives, thyme and rosemary. Bacto Clear capsules are an
excellent natural antibiotic.
• Garlic is able to kill bacteria, parasites and yeasts. Raw garlic
cloves can be grated, chopped very finely or pressed in a
garlic press, and then mixed well throughout your cooked
food and salads. It tastes nicer with some cold pressed olive
oil and organic apple cider vinegar. The organic apple cider
vinegar is cloudy, as it contains the probiotic culture called
“the mother”. If you cannot tolerate raw garlic, add the finely
chopped garlic towards the end of cooking the food. Onions
and leeks also have valuable antibiotic effects in the bowel,
so if you cannot tolerate garlic, you may find that these
things work well for you.
• Take probiotic supplements and use plain, Greek-style,
sugar-free yogurt to maintain ecological balance in the gut.
They are particularly good after antibiotic therapy.
• Some naturopaths recommend tea or powder from
Pau D’arco bark to fight yeast infections, while others
recommend the 8-carbon fatty acid called Caprylic acid,
which is safe and may help in mild cases. The drug called
Lufeneron can be obtained on the internet and is effective
to treat systemic Candida, which shows up as high levels of
Candida antibodies in the blood.
• Typical herbs used to destroy and expel parasites from the
body are black walnut hulls, chaparral, cloves, liquorice,
gentian and wormwood. Once again, all these herbs are
combined together in Intestinal Parasite Cleanse
capsules.

33
Probiotics
The word probiotic literally means to promote life. The term is
now used to describe living microorganisms in the intestines
that have positive health effects on an individual. The best-
known probiotics are acidophilus and bifidus, but there are
hundreds of others. An adult has approximately 6.6 pounds
(3 kilograms) of bacteria inside their intestines. We have far
more bacterial cells inside and on the outside of our body,
than we have human cells. This may sound alarming, but
these bacteria are critical for our good health and they are
particularly important for healthy immune function. The vast
amount of genetic material (DNA) in our body comes from the
microorganisms living inside our body and not from our own
human cells.
There are around 600 different species of bacteria in the
intestines and new species are continually being discovered.
The types of bacteria in your intestines, and their quantities,
have a profound effect on your health. Good bacteria are
anti-inflammatory, whereas bad bacteria secrete highly
inflammatory substances into the gut. Having high levels of
bad gut bacteria puts an enormous strain on your immune
system and hugely increases the amount of inflammation and
tissue destruction occurring in your body.
Dysbiosis is the term used to describe a bad balance of bugs
in your gut (too much bad bacteria and not enough good
bacteria).
Factors that increase levels of pathological (unhealthy, disease
-causing) bacteria in the gut include:
• stress
• poor dietary choices, especially excess sugar or
carbohydrates or excess alcohol consumption
• food intolerances and food allergies
• gastrointestinal infections from contaminated foods
and water
• medications, especially antibiotics, oral steroids, anti-

34
 inflammatory drugs and antacid drugs, which stop the
stomach from producing hydrochloric acid
A good probiotic supplement will help to correct the
imbalance of bacteria in your intestines and will do wonders
to reduce inflammation and help your immune system. It
will also help to heal a leaky gut (excessively permeable
intestinal lining). Eating yogurt is helpful, but it must be
unflavored and sugar-free, and still is not the most effective
way to take a probiotic. In order to get the right quantity and
the right strains of bacteria, you will need to take a probiotic
supplement in capsule or powder form.
Food for good bacteria is called a prebiotic. Prebiotics are
predominantly the indigestible fiber in certain vegetables
and fruit. Jerusalem artichoke is a particularly rich source of
prebiotics. This vegetable is in season during winter. Eating it
regularly will greatly increase the levels of good bugs in your
bowel.
An enormous amount of research has shown that improving
the composition of bacteria in your bowel greatly reduces your
risk of skin inflammation, autoimmune conditions, asthma, hay
fever, sinusitis and other allergic conditions.
Good intestinal bacteria also reduce the risk of vaginal
infections. The composition of flora in your bowel directly
determines the composition of your vaginal flora. Probiotics
reduce the risk of bacterial infections in the vagina (bacterial
vaginosis).
Lactobacillus bacteria are found primarily in the vagina and
gastrointestinal tract. Lactobacilli are part of the lactic acid
bacteria group, meaning most of the strains convert lactose
and other sugars to lactic acid, thus creating an acidic
environment, which inhibits the growth of some harmful
bacteria. Lactobacillus bacteria are recognized for their ability
to restore balance in the vaginal ecosystem and their anti-
inflammatory properties. Some research suggests they may
even have anticancer and antitumor effects.

35
Floratone is a rich probiotic blend, which supplies 1.1 billion
units of the most hearty strains of healthy bacteria, prepared
in a way that makes them particularly effective in implanting in
the intestines.
Floratone contains the following good bacteria:
• Lactobacillus rhamnosus, Bifidobacterium bifidum,
Lactobacillus acidophilus, Bifidobacterium infantis,
Bifidobacterium longum, Streptococcus thermophiles.
• Lactobacillus plantarum, Lactobacillus salivarius,
Lactobacillus reuteri, Lactobacillus casei, Lactobacillus
bulgaricus, Lactobacillus acidophilus DDS-1 and Lactobacillus
sporogenes.
The recommended dose is to take one or two capsules with 3
to 4 ounces of water, at least 20 minutes before breakfast.

36
9. R
 ecommended supplements to heal
skin affected by lichen sclerosus

Vitamin D
I recommend you take enough supplements of vitamin D3 and/
or get enough sunshine to keep your serum vitamin D levels
around 150 to 200 nmol/L or 70 to 100n g/mL. Vitamin D3
supplements are not expensive. A good way to optimize your
vitamin D level is through sun exposure, but for some people
this is not practical or possible, especially during the winter
months. As a very general guide, you need to expose 40
percent of your entire skin to the sun for 20 minutes between
the hours of 10 am and 2 pm. This is when the sun is at its
zenith. This should be avoided in those with fair skin, when it is
better to get sunshine after 3 pm and before 10 am.
If you’re using an oral supplement, recent studies suggest
that adults need around 3000 to 5,000 IU of oral vitamin D3
per day during winter, in order to get serum levels above 40
ng/ml. But this can vary a lot between individuals. Even the
conservative Institute of Medicine has concluded that taking up
to 10,000 IU per day poses no risk for adverse effects.
Excess vitamin D intake can cause elevated blood calcium
levels, so don’t over dose on it. It’s not a case of the more
the better. Get your blood level checked every 6 to 12 months
to find the dose of vitamin D3 that keeps you in the optimal
levels.

Zinc supplements
Blood zinc levels should be checked but may not be a true
reflection of chronically low zinc. So a zinc supplement is
worthwhile, especially if gluten intolerance has weakened
your immune system. I recommend a zinc supplement in a
dose of 10 to 25 mg daily with food. Some people get nausea
from zinc supplements, so take them with food and use the

37
lower doses, if nausea occurs. Zinc may help healing of lesions
caused by LS.

Vitamin A supplements
Vitamin A capsules in a dose of 5,000 to 10,000 IU daily can
help a lot to heal the damaged skin caused by LS. Take vitamin
A with fatty foods as it is a fat-soluble vitamin.

Vitamin E
Naturally-occurring vitamin E contains 8 different compounds.
Commercial vitamin E supplements focus on only 4 of these
compounds called tocopherols, while mostly leaving out the
4 tocotrienols that are rich in therapeutic and antioxidant
benefits.
Tocotrienols softgel capsules contain tocotrienols derived from
red palm oil from the Elaeis guineensis tree.
Avocadoes are very high in vitamin E and should be eaten
regularly. Due to their unique chemical structure, tocotrienols
provide potent, antioxidant benefits throughout the body.
Tocotrienols support healthy cell division, healthy skin and skin
healing.

Selenium supplements
Selenium deficiency is very common worldwide, and is more
prevalent in gluten-intolerant people. Blood tests for selenium
levels do not show your real total body selenium levels. You
may have selenium blood levels within the normal range, or
even slightly above the normal range, if you are supplementing
with high doses, but can still be deficient in selenium. This
is because selenium is concentrated and stored inside the
nucleus of cells and not in the plasma of the bloodstream.
Gluten intolerance reduces the absorption of selenium, as well
as zinc absorption, plus gluten-intolerant people, or those with
leaky gut or autoimmune diseases, have higher requirements
for selenium. It can take up to 4 months of selenium

38
supplementation to get your selenium stores up to adequate
levels to reduce signs of autoimmune diseases.
Selenium supplementation is vital for:
• lichen sclerosus sufferers.
• all women with an abnormal Pap smear or vulval warts
caused by the human papilloma virus (HPV). It is usually
possible to reverse an abnormal Pap smear result with
selenium supplementation. However, it is vital to remain
under the regular supervision of your gynecologist.
• those with recurrent genital herpes, cold sores, shingles or
recurrent viral infections of any type
Selenium is needed by your immune system to fight
inflammation, infections and cancer, so you do not want to
be low in selenium. Selenium deficiency is associated with a
higher risk of many types of cancer such as bowel, thyroid,
breast, oral, throat, skin, cervical and bowel cancer and also
cancer of the vulva. Gluten-intolerant people have a higher risk
of bowel cancer and lymphoma and selenium supplementation
can reduce this risk. I recommend 200 mcg of a selenium
supplement daily. An excellent supplement of selenium is
called Selenomune, which is available in capsule form; the
dose of Seleonmune is one capsule daily with food.

N-Acetyl Cysteine (NAC)

N-Acetyl Cysteine (NAC) is an amino acid derivative (small
protein) with over 40 years of scientific research to back it up.
NAC’s powerful health benefits derive from its ability to restore
intracellular levels of glutathione (GSH). Have you heard
of glutathione? If not, you need to know about it, because
it is the body’s most powerful naturally-produced internal
antioxidant.
NAC replenishes intracellular levels of glutathione (GSH), which
restores your cells’ ability to fight damage from free radicals,
known as reactive oxygen species.
NAC may be able to help those with chronic diseases, including
autoimmune diseases, liver disease and lung disease. Today,

39
researchers are now realizing just how vital glutathione’s
actions in the body are, and how many chronic disease
conditions are associated with glutathione deficiency. NAC
neutralizes toxins and pollutants, including heavy metals that
accumulate in the liver, kidneys and fatty parts of the body.
How can we get more glutathione in our body?
Oral glutathione supplements are available in some health food
stores and pharmacies and do not require a prescription. The
main problem is that glutathione is not well absorbed from the
gut, as it is broken down by digestive enzymes before it has a
chance to be absorbed. For this reason, it is far more effective
to take its precursor NAC, which is well absorbed from the
gut, if you take it 15 to 30 minutes before or 2 hours after
food. It is important to take NAC with a whole glass of water
to aid absorption. NAC is the most important precursor (raw
material) for glutathione synthesis. NAC is well absorbed from
the gut and is rapidly turned into glutathione.
For people with severely depleted levels of glutathione in their
body, taking glutathione intravenously is ideal, but this can
be expensive. The practical solution is to take NAC, the main
precursor to glutathione - a component the body’s cells need
to make their own glutathione.
NAC does not require a prescription and is taken as an oral
supplement in doses of 600 to 2400 mg daily. NAC is taken 2
to 3 times per daily, or as recommended by your healthcare
provider. NAC is best taken 15 to 30 minutes before food with
a whole glass of water.

Glutamine
Glutamine is an amazing amino acid, which is very busy in
your body. Indeed, glutamine is required by more metabolic
functions than any other amino acid. When the concentrations
of the different amino acids of blood plasma are measured,
glutamine is the highest.
Glutamine is an easily-used source of fuel (or food) for the
cells lining your intestines, and if the cells lining your gut

40
cannot get glutamine, they become damaged and can waste
away.
Glutamine protects the lining of the gastrointestinal tract
known as the mucosa. Glutamine supplementation maintains
the health of the mucosa (inner wall) of the gastrointestinal
tract and heals a leaky gut.
Glutamine is essential for healthy immune function and is an
aid for those with autoimmune diseases, including LS.
Therapeutic dosages of glutamine supplements range from 1.5
to 6 grams daily, divided into several separate doses. It is best
taken as L-glutamine in the form of a powder which is stirred
into cool water, juice or coconut milk and taken away from
food. Glutamine should not be mixed in hot beverages because
heat destroys it. Keep your glutamine supplements in a cool
dry place in an airtight container.
Note: Glutamine is different from monosodium glutamate,
glutamate and glutamic acid. Glutamine should not cause
symptoms (such as migraines, facial flushing or burning
sensation etc.) caused by allergy to monosodium glutamate.
Glutamine is not related to gluten, and those who are gluten
intolerant can use glutamine without problems.
Cautions: Patients with kidney or liver failure, or Reye
syndrome (a serious disease of childhood associated with
aspirin use) should not take glutamine. Many elderly people
have decreased kidney function and may need to reduce the
dose of glutamine.

41
10. H
 ormone treatment in women with
lichen sclerosus

The use of creams containing bioidentical hormones, such as

estrogen, progesterone and testosterone, can make a world of
difference to the health of the vulva and vagina in women with
lichen sclerous (LS). Hormone-containing creams are essential
in perimenopausal and postmenopausal women, who suffer
with both atrophy and LS of the vulva.
I generally use a cream containing a mixture of estrogen,
progesterone and testosterone. The type of estrogen I prefer
is one called Biest, which contains a combination of the two
estrogens called estriol and estradiol in a ratio of 80:20
percent respectively.
The doses I start with are Biest 2.5 mg, Progesterone 100
mg and Testosterone 2 mg per gram of cream. I prescribe
one gram of this cream daily. All of these hormones can be
combined in the same cream and the doses of each hormone
adjusted according to response.
Good results appear after several weeks with the vulva and
vagina becoming less inflamed, softer and more flexible. The
tissues will grow thicker and more robust and the clitoris can
increase in size. In most cases, sexual intercourse becomes
normal and enjoyable within several weeks.
These hormonal creams can be used long term for years, as
they are in low doses, are bioidentical and do not go through
the liver like hormone tablets do. Often after a good response
is achieved, the amounts of each hormone can be reduced.
These creams can also improve bladder problems, such as
infections, urinary frequency and urgency.
You need a doctor’s prescription for combination hormonal
creams and the amount of each hormone can be varied
depending upon the response. Unfortunately, not all doctors
are aware of how to use bioidentical hormones and quite a

42
few doctors do not even believe in them! This is frustrating for
women and this is why I can offer the service of international
consultations by phone and/or Zoom with my doctors, and a
compounding chemist then provides the cream which can be
posted to you. For this service see www.liverdoctor.com

How the hormones work

Biest contains two types of estrogen (estradiol and estriol).
Biest makes the tissues of the vagina and vulva thicker,
stronger and better lubricated. Younger premenopausal women
often require only a very low dose of Biest, compared to older
postmenopausal women.
Testosterone can increase the size of the clitoris, which has
often diminished in size and/or become distorted in shape by
the chronic inflammation caused by LS. The testosterone is
excellent for restoring a healthy libido.
The progesterone is used to balance the estrogen and
also promotes a better mood and relaxation of the mind.
Progesterone can also reduce heavy menstrual bleeding and
menstrual pains.
Tablets of hormones do not work as well as creams, as they
do not exert such a strong, local effect on the damaged
tissues in the vulva. Furthermore, tablets first pass through
the liver before they get into the blood circulation, and this
can increase the risk of side effects, such as an increased risk
of breast cancer, weight gain and blood clots. In contrast,
the small doses of hormones used in the creams work on the
local tissues and only small amounts get absorbed into the
bloodstream. This makes them much safer.
The hormone cream can be applied once daily at a different
time to the application of steroid creams. The hormone cream
should be massaged into the areas of the vulva and perineum
that are affected by the LS and/or atrophy.
It is a relief to know that most of the skin damage caused by
LS can be largely reversed by the combination of hormones
and supplements that are recommended in this book.

43
All women with LS should have an annual examination
by a medical doctor, and in severe cases by a specialist
gynecologist. The affected areas in the vulva and perineum
need to be closely inspected and any areas suspicious for
precancerous changes must be biopsied.

44
11. G
 luten sensitivity – Could it be an
issue in lichen sclerosus ?

Gluten sensitivity is often associated with LS, as well as other

autoimmune diseases. Gluten sensitivity is best described as
an intolerance to the ingestion of the protein gluten, which is
found in certain grains and many processed foods.
Gluten sensitivity or intolerance is also known as non-celiac
gluten sensitivity (NCGS), as it occurs in people who do not
have celiac disease. Yes, that’s correct! You can be intolerant
to gluten, even though you do NOT have celiac disease.
People with gluten sensitivity are unable to tolerate gluten
in their diet and if they ingest it, they may experience a vast
array of symptoms. Gluten sensitivity is extremely common
and often goes unrecognized. Many people may attribute
their poor health to being run down or overstressed, when
in reality their underlying problem is actually associated with
their diet. Recent studies have found that gluten sensitivity
may be associated with immune dysfunction. Gluten sensitivity
is caused by abnormal immune responses. Gluten confuses
our innate immune system, triggering it into an overreaction,
even though it is not a direct threat to our health. This trigger
creates a cascade of inflammation, not just in the gut, but
throughout the body, causing excessive inflammation in
different organs and tissues. The onset of gluten sensitivity can
occur at any time throughout your life.
Gluten is a protein which is found in many common foods in
our diet. Gluten helps foods keep their structure, gives food an
appetizing bouncy texture and helps bread rise and hold form.
Gluten is widely used as an additive in foods which have low-
protein content, because it is so highly available and cheap.
This means, that gluten is often added to products without
people knowing. Many products you use daily could have
hidden gluten.

45
Chronic inflammatory skin problems such as eczema, psoriasis,
dermatitis and lichen sclerosus are commonly found in people
with gluten sensitivity. The skin is our body’s largest organ and
a main organ of toxin elimination. So you can imagine it would
be one of the first places we would notice an inflammatory
reaction. It is also important to check cosmetic products, as
they often have gluten added to them as a binder and you may
experience contact dermatitis from this.
The HLA-DQ genotype test is a blood test which can check
if you have the genetic pattern that predisposes you to non-
celiac gluten intolerance or celiac disease. People are born with
a genetic predisposition to developing these problems. They
inherit a particular genetic make-up (HLA-DQ type), with the
genes HLA-DQ2 and HLA-DQ8 being identified as the “celiac
genes”. More than 95 percent of persons with celiac disease
have either the HLA-DQ2 or HLA-DQ8 genetic pattern, but not
all of them will get celiac disease. However, they are more
likely to have non-celiac gluten sensitivity (NCGS).
If you are found to have this genetic make-up, then you may
be a carrier of celiac disease, or you could have undiagnosed
NCGS. In many cases, gluten intolerance or even celiac
disease, will not have been diagnosed in previous family
generations. However, a first-degree relative (brother, sister,
parent or child) of a person with celiac disease has about a
10 percent chance of also having the condition. Even if you
do NOT have the HLADQ 2 and HLADQ 8 genetic pattern
that is associated with celiac disease, you may still be gluten
sensitive. So this blood test is just a guide. If you are negative
for this test, you may still benefit from a gluten-free diet,
which could alleviate your symptoms.

Elimination diet
The best way to test if you are gluten intolerant is to eliminate
ALL gluten-containing foods from your diet for 3 to 6 months
and observe the difference in your health, your bowel function
and lichen sclerosus. It is important to remove ALL gluten, so
make sure you check the labels of everything you eat. Gluten

46
is a thickening agent and is constantly added to processed
foods, such as salad dressings, sauces, stock and soup mixes,
and even to certain brands of vitamins or medications.
If you fail to remove ALL the gluten from your diet, your
immune system will still be reacting to small particles of
gluten, leaving you with low-grade systemic inflammation
throughout your body. This will mean that your symptoms will
not completely resolve.
After this gluten-free period, eat gluten again and see how you
feel. This is called “challenge testing”. If you feel unwell, or
your LS flares up after eating gluten, then you should stay off
gluten permanently. Remember, that it may not only be your
bowel movements that are affected. Check your skin, general
mood, energy levels and even quality of sleep.

47
12. Your diet and lichen sclerosus

The types of bacteria in your gut reflect the types of foods that
you eat on a regular basis. It is vital to increase the amount
of fruits and vegetables in your diet and ideally 50 percent
of your diet should consist of raw and cooked vegetables and
some raw fruits. If you have a sensitive digestive system and
find it hard to digest raw foods, you will need to blend or grate
the harder vegetables with a food processor and chop leaves
more finely. Juicing the vegetables is a great way to increase
the absorption of healing, anti-inflammatory nutrients from the
produce. You will need to purchase a juice-extracting machine
or a high-powered blender that can turn the vegetables into a
liquid juice or soup. I recommend around 250 to 300 ml daily
of raw vegetable juice, which is not a lot, but enough to work
on reducing inflammation. If you are a super busy person,
you can make a whole week’s supply of juice at one time and
pour it into glass jars that you have left over from shopping.
Leave 2 inches of space at the top of the juice and put the
lid on tightly. Place the jars in the freezer straight after you
have made the juice. If you freeze the juice immediately after
making it, you will preserve all the active-healing ingredients
and indeed the juice will be preserved perfectly for months.
Take a jar of juice to work each day and drink it whilst it is
still semi-frozen (like a slushy), or if you don’t like cold drinks,
allow it to thaw completely and stir well before drinking.

Ingredients to juice
• Citrus, carrot, beet, celery, cucumber, zucchini, cabbage and
ginger
• Green leaves, such as spinach, kale, rocket, cabbage
• Herbs, such as mint, cilantro (coriander), parsley, chives
and basil

48
13. O
 ther treatments for lichen
sclerosus

It may be worthwhile to see a dermatologist (skin specialist),

who has a special interest in the vulva and vagina.
Sometimes, a dermatologist will prescribe oral drugs such as
Etretinate, Tegison, Acitretin, Neotigason etc. capsules. The
dose is 25 mg daily. These drugs are a synthetic vitamin A
derivative (retinoid). They can have side effects and their use
must be monitored. Unfortunately, the LS comes back when
these drugs are stopped.
Retinoid drug side effects can include birth defects, thus it
must be avoided in women of childbearing age unless they
have contraception.
It is safer to use these retinoid drugs topically, such as the
drug Tacrolimus cream (brand name is Protopic).

Treatments that do not heal lichen sclerosus

• Laser therapy will only damage the inflamed skin more
• Antibiotics do not heal
• Pain killers do not heal
• Local anesthetics do not heal the tissues, they only relieve
the itch/discomfort

Surgery for lichen sclerosus

If scar tissue is causing constriction or narrowing of the
opening of the vagina, it may become impossible for sexual
intercourse to occur. The hood of the clitoris may become fused
to the clitoris itself, causing great problems with a woman’s
sex life.
In such cases, specialized surgery to remove the scarring
and widen the vaginal opening and to free up the clitoris may
be done with excellent results. You need to have this type

49
of surgery done by an excellent surgeon who specializes in
surgery of the vulva. Also, it is important to have ongoing
treatment of the inflammation, or the scar tissue may return,
causing the vaginal opening to become constricted again and
the clitoris to be hidden again.
Scar tissue may be reduced by taking:
• Vitamin E and vitamin A supplements orally and as creams.
• Vitamin C and MSM (Methyl Sulphonyl Methane) in a
powder form. MSM is an organic form of sulfur.
• Serrapeptase, a natural enzyme that may reduce scar
tissue and is available in capsule form. Dose is 2 capsules,
twice daily.

Platelet-rich plasma (PRP) – A novel treatment

for lichen sclerosus
Some vulvar disorder specialist surgeons are testing a new
and safe treatment, where the patient’s own platelet-rich
plasma is injected with tiny needles into areas affected by
LS. The platelets release a growth hormone, which stimulates
the production of healthy, new collagen in areas which have
lost elasticity and tissue depth. PRP can reduce scarring and
inflammation and is therefore a very promising, albeit new
treatment.
The LS must be active for PRP to be used. The first treatment
is repeated after 6 weeks and results assessed after 14 weeks.
PRP is generally well tolerated because it is using the patient’s
own platelets, so there is no risk of allergy. An excellent
website and webinar on PRP treatment for LS can be found at
www.lichensclerosustreatment.com

50
14. Bacterial vaginosis and vaginal odor

If you suffer with vaginal discharge and/or odor, this is usually

due to the wrong pH (acid-base) balance in the vagina, which
encourages the growth of unfriendly bacteria.
It is the bacteria which cause the offensive odor. Bacterial
vaginosis results from overgrowth of one or more of several
bacteria found naturally in your vagina. Ideally, “good” bacteria
(known as lactobacilli) outnumber “bad” bacteria (anaerobes).
The anaerobes thrive in an environment where there is no,
or little oxygen, and the acidity is low. Too many anaerobic
bacteria disturb the natural balance of microorganisms in your
vagina and cause bacterial vaginosis and odor.

Tests that can be done for diagnosis of bacterial vaginosis

A sample (swab) of vaginal secretions should be taken. This
is done to check for an overgrowth of anaerobic bacteria in
your vaginal mucus. Your doctor may examine the vaginal
secretions under a microscope, looking for “clue cells”. Clue
cells are vaginal cells covered with bacteria that are a sign of
bacterial vaginosis. A swab of the vaginal mucus should be
taken for culture to determine what type of bacteria or fungi
are growing in the vagina.
It is good to test the vaginal pH and your doctor may check the
acidity of your vagina by placing a pH test strip in your vagina.
A vaginal pH of 4.5 or higher is a sign of bacterial vaginosis
and represents an environment which is not acidic enough.
There may be infection with bacteria higher up in the vagina
and the uterus and tubes, in which case, pelvic pain may be
present. If this is suspected, a swab should be taken from
the cervix. In such cases, antibiotic drugs may be needed for
2 weeks.

51
Drug treatment for bacterial vaginosis
Some women use antibiotic drugs for bacterial vaginosis, but
if they are overused, this will cause Candida to flourish, which
then causes itching of the vagina and vulva, and perhaps a
white foamy vaginal discharge.
To treat bacterial vaginosis, your doctor may prescribe one of
the following medications:
• Metronidazole (Flagyl, Metrogel-Vaginal) - This
medicine may be taken orally as a pill. Metronidazole is also
available as a topical gel that you insert into your vagina. To
reduce the risk of stomach upset while using this medication,
avoid alcohol during treatment.
• Clindamycin - This medicine is available as a cream that
you insert into your vagina. Clindamycin cream may weaken
latex condoms during treatment and for at least 3 days after
you stop using the cream. Clindamycin can be taken orally,
but is very strong and can cause digestive and intestinal
upset.
• Tinidazole - This medication is taken orally and can cause
stomach upset and nausea, so avoid alcohol during.
It is generally not necessary to treat an infected woman’s
male sexual partner, but bacterial vaginosis can spread
between female sexual partners. Female partners should seek
testing and may need treatment. It is especially important for
pregnant women with symptoms to be treated. This will help to
decrease the risk of premature delivery or low birth weight.

Naturopathic treatment approach for bacterial vaginosis

Bacterial vaginosis tends to recur if we do not treat the cause.
It is important to improve the bacterial flora in the gut by
taking a good probiotic and improving the diet. Naturally-
fermented foods, such as sauerkraut, miso, kombucha and
kimchi etc., provide hundreds of beneficial bacteria for the
gut. You can make these fermented foods yourself or purchase
them from the refrigerated section of your health food store
or supermarket.

52
Sugar, processed foods and fast foods should be avoided.
Sugar feeds the growth of bad bacteria and fungi in the gut
and this leads to more bad bacteria in the vagina. Plain,
acidophilus yogurt is a good thing to eat regularly, but avoid
sweetened varieties. Just add your own fresh fruit. The type of
bacteria in your vagina reflect the type of bacteria in your gut.
Natural antibiotics can be used for extended periods and make
a big difference. They include:
• fresh herbs, such as rosemary, oregano, thyme, basil,
cloves, horseradish and garlic
• natural antibiotic capsules, such as the supplement called
Bacto Clear
Each capsule of Bacto Clear contains:
• herbal extract equivalent to:
- Phellodendron amurense (equivalent to berberine 17.81
mg) 750 mg
- Origanum vulgare leaf
• essential oils:
- Oregano 100 mg
- Thymus vulgaris essential oil (thyme) 50 mg
- Syzygium aromaticum essential oil (clove bud) 50 mg
The dose of Bacto Clear is 1 to 2 capsules, twice daily
with food. These capsules have an acid-resistant coating,
so that the stomach acid does not destroy their therapeutic
effectiveness. Bacto Clear may need to be taken for extended
periods and this is safe to do.
I also recommend you take a supplement of vitamin C 1,000
to 2,000 mg daily and a supplement of selenium 150 to 200
mcg daily to boost your immune system, as this can result in a
big improvement in the symptoms of bacterial vaginosis.
Vaginal Candida can respond well to vaginal pessaries made
with boric acid in a dose of 600 mg per pessary and this is
a safe and natural approach that can be used for a 2-week
course and repeated if needed. Insert the pessary on retiring
at night.

53
Vaginal douching
The use of vaginal douching is controversial, and most doctors,
books and websites do NOT recommend it. However, I do
think vaginal douching can be very useful in reducing bacterial
vaginosis, discharge and odor. I have found it to be very safe,
however, I do not recommend it during pregnancy. I have
found that douching the vagina every few days, or even just
once a week, can greatly reduce the symptoms.

Common type of vaginal douche

You need to buy a vaginal douche from the chemist or online.

The douching of the vaginal cavity is best done when lying
down in an empty bath to flush out the vagina.
You can make up your own douche mixture, as commercial
douche solutions may be chemical and irritating.

54
Here is what you do:
• Boil water and allow to cool so that it is still warm.
• Mix the douche mixture thoroughly in this water.
• Fill the douche with this mixture.
• Lie in an empty bath and flush out the vagina. Usually once
is enough but you can do it twice, if you find this more
effective.
The douche mixture contains:
• 1/8 tsp of a natural organic herbal shower gel
• 1 tbsp of colloidal silver
• 1 drop of tea tree oil
• 1 drop of iodine
In women with vaginal atrophy and/or LS, the skin of the
vagina and vulva is thinner and more fragile and thus prone to
infection with unhealthy bacteria. In such cases, this type of
regular douching can help a lot.

55
15. Your sex life

Lichen sclerosus (LS) can obviously impact adversely the

sex life of a woman, as the damaged tissues in the vulva
may cause discomfort and dryness during intercourse. In my
medical practice, our holistic doctors are frequently asked
for help by women with poor sex drive and/or painful sexual
intercourse, and this subject is often broached with a little
reticence.
When I tell women that I can restore their libido, they often
say: “Oh that’s great, my partner will be pleased.” I find this
amusing and usually reply: “Well, it’s you I’m concerned
about!”

Causes of poor libido

Poor libido is a very common complaint in:
• women with painful conditions of the vulva, such as LS or
vaginal and vulval atrophy, due to loss of sex hormones
• women with hormonal imbalances during menopause and
the postnatal period
• after hysterectomy
• busy career women who are too tired and stressed to relax

How can we help the libido?

In younger women who are tired or stressed, often an
improvement in diet and lifestyle with the addition of
nutritional supplements will restore the libido. Make sure you
check blood iron levels, as low iron is the most common cause
of fatigue in women, especially if they have heavy menstrual
bleeding. This can be overcome in many cases with the use
of a 10 percent strength progesterone cream. The cream will
make the periods much lighter and increase the sex drive.
If the poor libido occurs after childbirth, then blood tests to
measure the hormone levels will be needed. The use of some

56
natural hormone therapy can work wonders, not only for the
libido and the woman’s relationship, but also for the emotional
wellbeing. Usually a cream containing natural progesterone 10
percent and testosterone 0.2 percent will restore the libido.
Some types of oral contraceptive pills (OCP) can greatly
reduce the sex drive, because the synthetic hormones in the
OCP will suppress the production of the body’s own natural
sex hormones. It may be wise to look at alternatives to the
conventional OCP, such as the hormone implant or fallopian
tubal implants.
In menopausal women, it is important to look at the need
for hormone replacement therapy (HRT). Some types of oral
HRT will not restore the libido, because they cause the liver
to produce a binding protein called “sex hormone binding
globulin” (SHBG).
I have found that the use of creams containing a tailormade
combination of natural bioidentical hormones, can be very
effective for women who have sexual difficulties.
After hysterectomy, natural HRT can be used to prevent
the sudden onset of menopause and can overcome physical
problems that may otherwise interfere with the sex life.
Some women not only have a deficiency of female hormones,
but also male hormones.
A balance of the female and male hormones is needed for a
fulfilling sex life.
Thankfully, it is now possible to administer much smaller
doses of androgens (male hormones) to women via creams or
troches (lozenges) and thus side effects can be avoided.
For more information see my books Hormone Replacement -
The Real Truth and Increase Your Sex Drive Naturally.

Painful sex
The tissue damage caused by LS does not go up into the
vagina. However, the opening of the vagina can become
scarred, eroded and eventually narrowed and constricted. This

57
can make sexual intercourse painful or impossible if allowed
to progress, which makes early treatment essential. LS can
be associated with vulvar vestibulitis (inflammation of the
lubricating glands in the vaginal opening), which can lead to
chronic pain and dryness in the vulva. If pain in the vulva
area becomes chronic, it is called vulvodynia. This pain can
be described as throbbing, burning, stinging in the vulva, up
inside the vagina and a dull ache extending into the groins and
upper thighs. Vulvodynia is not uncommon and affects around
15 percent of women. It is often misdiagnosed by doctors, who
do not understand that it can occur without any obvious cause.
Vulvar vestibulitis causes pain when an area of the vulva called
the vestibule is touched. Even after LS has been effectively
treated, vulvodynia can persist. In such cases, it is vital to use
nutritional therapies and seek counselling from a doctor who
specializes in this problem.

58
What can cause pain in the vulva?
• Infection with the human papilloma virus (HPV). This
virus may cause deep inflammation in the vulva and/or
vulvar warts and this can present as a burning and itching
sensation.
• Bacterial infection of the vagina and vulva can cause
discharge, tenderness and swelling.
• Infection with the herpes virus, which can attack the vulva
and is known as genital herpes.
• Infection with the bacteria that causes syphilis, which can
cause an ulcer on the vulva.
• Candida or thrush (yeast infection) can cause itching,
swelling and discharge.
• Vulvar cancer which can be caused by LS or the wart virus
(HPV) and will show as an ulcer or lump on the vulva and
often bleeds on touching.
• Lichen sclerosus can cause severe itching and pain in the
vulva and perineum and itching around the anus.
• Allergic dermatitis caused by an allergic reaction to
detergents, fragrances, lubricants, tampons, sanitary pads,
spermicides, fabric dyes etc.
• Lichen planus, which is an autoimmune disease that can
attack mucous membranes, including those in the vagina
and vulva.
• Muscle spasm in the vaginal and rectal muscles caused by
chronic anxiety or magnesium deficiency.
• Sexual abuse from childhood years can trigger painful
muscle spasms in the vagina.
The proper diagnosis can be assisted by taking swabs to
culture all these bacteria, yeasts and viruses. Biopsy of areas
suspicious for cancer is essential.

59
16. Cancer of the vulva

Cancer of the vulva is not common and gradually grows over

many years. Most cancers that arise in the vulva are squamous
cell carcinomas, which arise from the mucous membranes and
skin of the vulva.

What causes cancer of the vulva?

The cause is not always known and can be due to the
interaction of several factors.
• Lichen sclerosus can cause cancer in 3 to 5 percent of
women. Tthis equates to 1 in 20 to 1 in 33 women with LS.
• The next most common cause is infection with the human
papilloma virus (HPV). This starts with a precancerous skin
lesion, known as vulvar intraepithelial neoplasia (VIN). This
may be found in several areas of the vulva before cancer
tissue develops.
• Vulvar cancers that are not caused by HPV infection might be
linked to a mutation (damage) in the P53 tumor suppressor
gene that protects cells from turning cancerous.
• Smoking increases the risk of vulvar cancer.
• Deficiencies of selenium increase the risk of cancer of the
cervix and vulva.
Cancer of the vulva can cause the following symptoms:
• Chronic itchiness in the vulva area.
• Burning, pain, discomfort and tenderness in the vulva.
• Irregular bleeding from the vagina or vulva area.
• Changes in the appearance of the vulva. The color of the
skin may change or thickening of the skin may occur.
• Lumps that have a wartlike appearance, or an ulcer or sore
that may bleed on touching.

60
How can we test for cancer of the vulva?
• Colposcopy and biopsy of the vulva is done to suspicious-
looking areas. Once the suspicious area is determined,
a local anesthetic injection is given to carry out either
excisional or punch biopsy for the removal of the dubious
tissue.
• Staging tests are undertaken to establish the size, location
and extent of spread of the cancer and helps to determine
the treatment that would provide the best outcome. The
doctor would carry out the following tests to collect this
data, that would include examining the inside of the bladder
(cystoscopy), a physical pelvic examination and this may
require a general anesthetic. Imaging tests, like a chest
X-ray, CT-scan, MRI scan and PET scan, to check whether
the cancer has spread. The outcome of the staging tests
help one determine the stage of the cancer such as stages 0,
I, II, III, IVA, IVB. The stages represent the extent of spread
with stage 0 being the preliminary stage and stage IVB
depicting the spread to distant locations like lungs or even
the brain.

Cancer sore of the vulva

Prevention of cancer of the vulva

• Have a regular (at least annual examination) of your vulva
from a gynecologist. This is even more vital if you suffer with
lichen sclerosus or infection with the human papilloma virus
(HPV). Going in for regular gynecological screening to detect

61
 and biopsy any suspicious precancerous lesions that could
lead to vulvar cancer. When diagnosed in the early stages, it
can be effectively treated and cured.
• Continue treating your LS with steroid creams.
• Practise safe sex by using a condom to minimize the risk
of catching a sexually transmitted disease like HPV, HIV or
syphilis, as these infections raise the risk of cancer. Condoms
greatly reduce the risk of getting HPV, although they do not
totally safeguard against HPV.
• The HPV vaccination may be beneficial in averting cancer of
the vulva and cervix. However, it can have side effects and
does not protect you against all strains of HPV.
• Stopping smoking lowers the risk of vulvar cancer.
• Maintain a healthy diet and lifestyle.
• Ensure you take a selenium supplement regularly, as this
is proven to reduce cancer risk. Other supplements that
have been shown to reduce cancer include vitamin D and
vitamin C.

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17. Get lichen sclerosus treated early

If you neglect lichen sclerosus (LS), scar tissue may build up

and this can lead to a localized skin cancer developing in this
tissue. This occurs in less than 10 percent of women with
LS, but it is essential to see your gynecologist regularly for
a checkup of affected areas. Areas of LS that develop sores,
ulcers and cracks that last for weeks, are also susceptible to
cancer. Lesions that bleed easily or raised lumps that grow
rapidly, may be suspicious. If we can treat suspicious areas
early, we can prevent cancer of the vulva.
Even if the symptoms disappear, it is essential to treat LS
for the rest of the patient’s life, as cancer can still develop in
diseased tissues.

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International Society for the Study of Vulvovaginal
Disease
ISSVD – ISSVD Website
www.issvd.org
The World’s #1 Resource for Vulvar Education and Research ·
Provides information on vaginal and vulval problems and a
data base of doctors who specialize in these problems

Vulvar Pain Foundation

www.vulvodynia.com

American College of Obstetricians and Gynecologists

www.acog.org

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